Skip to main navigation
Skip notifications
Access to POEMs and Essential Evidence Plus will no longer be included in CMA membership as of Dec. 1, 2023.
Search
Oral therapy as effective as intravenous therapy for endocarditis, bacteremia, and osteomyelitis
Clinical Question
Do endocarditis, bacteremia, and osteomyelitis need to be treated with intravenous antibiotic therapy?
Bottom line
Dogma denied: Three "big" infections — osteomyelitis, bacteremia, and endocarditis — can be treated just as well with oral antibiotic therapy as with IV antibiotic therapy. 1a-
Reference
Study design: Meta-analysis (randomized controlled trials)
Funding: Government
Setting: Various (meta-analysis)
Synopsis
These authors searched PubMed and reference lists of retrieved articles, identifying 20 randomized controlled trials and one quasi-randomized study comparing intravenous (IV) treatment with oral treatment of osteomyelitis (n = 7), bacteremia (n = 9), and endocarditis (n = 4). Almost all the studies were conducted in adults; 3 studies were conducted in children with bacteremia. Three authors selected studies for inclusion. Study quality was not assessed. I worry the authors may have missed applicable research; their search strategy was limited to one database, they used just few keywords, didn't attempt to find unpublished data, and excluded any articles without an abstract available. However, their analysis found no evidence of publication bias. For endocarditis, the 2 largest studies compared IV therapy with oral therapy from the start of treatment or after a week of IV therapy, both finding a small benefit to oral therapy. For bacteremia, most studies evaluated oral linezolid (Zyvox, Zyvoxid) or ciprofloxacin, finding no difference in outcomes. Standard oral and standard IV treatments for osteomyelitis produced similar outcomes. There was little heterogeneity among the study results.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
no
none
We need an explanation.
We had a rationale for why IV works better, now we need a rationale for why it doesn't!
IV vs Oral antibiotics in Osteomyelitis and Endocarditis
Very interesting
oral vs parenteral antibiotics
less complicated as good
Oral vs IV antibiotics for OM, bacteremia and endocarditis
Adoption of oral compared to IV administration would be a game changer however the limitations in the literature search that the reviewer describes could be important ones. Seems to me someone needs to repeat the review with a more robust search and if it comes to similar conclusions then game on!
Little difference in efficacy between oral nd parenteral tre
In situations of I've threatening infections like bacteremia osteomyelitis and endocarditis the treating team should tmist Care in ascertaining the gastric tolerance , geopardy of bowel commensals population, patience compliance ,associated common symptoms of nausea and vomiting. Taking in to consideration of these factors it can not be generalized that IV drug administration is no way superior to real therapy .
iv vs oral antibiotics
oral meds just as effective as IV drugs for endocarditis, sepsis and osteomyelitis