Are Oral Antibiotics Superior To IV Antibiotics For Bone And Joint Infections?

In a recently published study involving 1.054 patients with bone and joint infection, study authors found that oral antibiotics are noninferior to intravenous (IV) agents.¹

Seven days after surgery, half the patients received oral antibiotics and half received IV antibiotics for six weeks, according to the randomized study, which was published in the New England Journal of Medicine. At one-year follow-up, the study notes treatment failure occurred in 14.6 percent of the IV group and 13.2 percent of the oral antibiotic group.

The real take-home message is that if the patient has a functioning gut and one has performed appropriate surgical intervention as necessary, then the clinician can probably feel comfortable in treating someone with an oral antibiotic just as much as with its parenteral equivalent.

In fact, one could probably find a lot of downside to using IV antibiotics, not just peripherally inserted central catheter complications but things like acute kidney injury or a long-term modification of the patient’s microbiology, which can have implications we do not understand yet. This may also be true of oral antimicrobials but is probably less true in comparison to the potential risks with IV antibiotics.

Reference

1. Li HK, Rombach I, Zambellas R, et al. Oral versus intravenous antibiotics for bone and joint infection. N Engl J Med. 2019; 380(5):425–36.

For further reading, see “Point-Counterpoint: Are Oral Antibiotics Better Than IV Antibiotics For Osteomyelitis?” in the February 2019 issue of Podiatry Today.