Wednesday, 22 May 2019

You are here

No Difference in Oral or IV Antibiotics for Bone & Joint Infections

Research from the NEJM shows that oral antibiotic therapy was noninferior to intravenous antibiotic therapy when used during the first six weeks for complex orthopedic infections.

There is considerable discussion whether complex bone and joint infections must be managed with prolonged intravenous antibiotics or if oral antibiotic therapy may suffice. 

This was a multicenter U.K. study that enrolled 1054 adults who were being treated for bone or joint infection who were randomized (within 7 days after surgery or antibiotic treatment) to receive either intravenous or oral antibiotics to complete the first 6 weeks of therapy. The primary end point was definitive treatment failure within 1 year after randomization. In the analysis of the risk of the primary end point, the noninferiority margin was 7.5 percentage points.

Treatment failure occurred in 14.6% of the IV group and 13.2% of the oral group. This met the definition of non-inferiority with the difference in treatment failure (oral group vs. intravenous group) of −1.4 percentage points (90% confidence interval [CI], −4.9 to 2.2; 95% CI, −5.6 to 2.9).  There was no difference in serious adverse events (27.7% IV vs 26.2% oral). 

This trial suggests that oral antibiotic therapy for 6 weeks may be as effective as IV antibiotics and that further studies of oral antibiotics are indicated. 

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Steroids, Not Biologics, Drive Arthroplasty Infections in RA

Medicare and Truven MarketScan administrative data study (2006 through 2015) of rheumatoid arthritis (RA) undergoing arthroplasty found that while that the risks of perioperative infection was similar across biologics, the infection risk with glucocorticoid use, especially at > 10 mg/d, was significantly greater.

Generic Price Fixing Alleged by State Prosecutors

The NY Times and 60 Minutes have reported that Connecticut, along with 43 other states, filed a mega-lawsuit accusing the generic drug makers of a massive, systematic conspiracy to bilk consumers out of billions of dollars. (Citation source: https://buff.ly/2vSmv03)

Drug Pricing Regulations in US and Canada

Reuters reports on regulatory efforts by Canada and the US to curb the rising cost of drugs, especially expensive new medicines. 

In Canada, a little-known government agency is increasing its oversight of expensive drugs sold in Canada. The federal Patented Medicine Prices Review Board (PMPRB) is targeting an increasing number of expensive drugs introduced in the last several years by drug makers.

Nonadherence is Costly for Patients in Pain

A comparative cohort study of patients with osteoarthritis (OA), gout, diabetic peripheral neuropathy (pDPN), post-herpetic neuralgia (PHN), and fibromyalgia (FM) shows that nonadherence to pain medications is high and leads to greater overall health care resource utilization and costs. 

Naproxen has no Effect on Alzheimer's

A randomized controlled trial shows that chronic low-dose naproxen does not reduce progression of presymptomatic Alzheimer disease (AD).

The INTREPAD trial was a 2-year double-masked prevention trial, that enrolled 195 AD who were randomized 1:1 to naproxen sodium 220 mg twice daily or placebo. The primary outcome was rate of change in a multimodal composite presymptomatic Alzheimer Progression Score (APS).