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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.