IDWeek 2019 — Partial oral treatment for bone, joint infections rivals IV therapy


  • Marielle Fares, Pharm.D.
  • Conference Reports
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Takeaway

  • Oral antibiotic therapy is noninferior to intravenous (IV) antibiotic therapy when used during the first 6 weeks for orthopedic infections, as assessed by treatment failure at 1 year.

Why this matters

  • Oral antibiotic therapy is noninferior to IV therapy for this indication and may be considered to reduce hospital length of stay and the rate of complications.

Study design 

  • Open-label, randomized, multicenter UK clinical trial, 1054 patients with osteomyelitis, joint infections, prosthetic joint infection, fixation device infection.
  • Patients were randomly allocated 7 days after surgery or after starting antibiotic treatment to receive oral (n=509) or IV antibiotics (n=509) for 6 weeks of therapy.
  • Agents: Staphylococcus aureus (38%), coagulase negative (27%), Streptococci (14%),  pseudomonas (5%), others.
  • Primary endpoint: definitive treatment failure within 1 year; noninferiority margin, 7.5%.

Key results 

  • Treatment failure in 74 patients (14.6%) vs 67 (13.2%) in the oral group.
  • Difference in risk for definitive treatment failure was −1.4 points (95% CI, −5.6 to 2.9), indicating noninferiority.
  • No significant between-group differences in adverse events (27.7% in IV vs 26.2% in oral group), but catheter-related complications were more frequent in the IV group (9.4% vs 1.0%). 

Limitations

  • Short follow-up, given the long-term risks of failure in osteomyelitis.