Early switch from IV to oral antibiotic treatment in bone infections
Abstract:
Objectives: The timing of the switch from intravenous (IV) to oral antibiotic therapy for orthopaedic bone and joint infections (BJI) is debated. In this narrative article, we discuss the evidence for and against an early switch in BJIs.
Sources: We performed a PubMed and Internet search investigating the association between the duration of IV treatment for BJI and remission of infection among adult orthopaedic patients.
Content: Among eight randomized-controlled trials and multiple retrospective studies, we failed to find any minimal duration of postsurgical IV therapy associated with clinical outcome. We did not find scientific data to support the prolonged use of IV therapy or to inform a minimal duration of IV therapy. Growing evidence supports the safety of an early switch to oral medications once the patient is clinically stable.
Implications: Following surgery for BJI, switch to oral antibiotics within a few days is reasonable in most cases. We recommend making the decision on the time point based on clinical criteria and in an interdisciplinary team at the bedside.
Reference:
Sendi P, Lora-Tamayo J, Cortes-Penfield NW, Uçkay I. Early switch from IV to oral antibiotic treatment in bone and joint infections. Clin Microbiol Infect. 2023 May 12:S1198-743X(23)00232-X. doi: 10.1016/j.cmi.2023.05.008. Epub ahead of print. PMID: 37182643.