Oral = IV antibiotics for serious bone and joint infections

Reference

Li HK, Rombach I, Zambellas R, et al, for the OVIVA Trial Collaborators. Oral intravenous antibiotics for bone and joint infection. N Engl J Med 2019;380(5):425-436.

Synopsis

The researchers identified adults with one of the following infections: osteomyelitis of the extra-axial skeleton, native joint infection requiring excision arthroplasty, infection of a prosthetic joint or orthopedic fixation device, or vertebral osteomyelitis. All patients would have typically been treated with IV antibiotics. They were randomized within 7 days of either surgery or (if no surgery) the start of antibiotic therapy to receive IV or oral antibiotics. The antibiotics were selected on the basis of cultures, sensitivity, and other clinical factors by an infectious disease consultant. Of the 1054 recruited patients, 39 had no end point data, so the modified intention-to-treat analysis includes 1015 patients. The mean age of participants was 50 years, 64% were men, and all had some kind of surgical debridement or device removal. The most common identified organisms were Staphylococcus aureus (38%) and coagulase-negative staphylococci (27%). This was a noninferiority trial, which is appropriate since the goal was to evaluate the efficacy of a simpler, cheaper treatment option. Approximately 80% of patients in the IV group received 6 weeks of IV antibiotics; 90% of patients in the oral group received less than 7 days of IV antibiotics. For the primary outcome of treatment failure, oral therapy was equivalent at one year to at least 6 weeks of IV therapy (14.6% in the IV group vs 13.2% in the oral group; 95% CI for the difference -4.9% to 2.2%). There was no difference in overall quality of life or in hip function scores, but knee function scores showed greater improvement in the oral treatment group. The length of hospital stay was 3 days longer in the IV treatment group. Although there were more catheter-related complications in the IV group, the overall rate of serious adverse events was similar between groups.