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