Oral antibiotics demonstrate similar rates of success and complications compared to parenteral antibiotics for bone and joint infections: a systematic review and meta-analysis.

IF 5.4 2区医学 Q1 INFECTIOUS DISEASES

Infection Pub Date : 2025-05-15 DOI:10.1007/s15010-025-02517-9

Gabriella Schreiner, Stephen Fucaloro, Jesus Meija, Laura Krivicich, Matthew Salzler

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引用次数: 0

Abstract

Purpose: Bone and joint infections (BJIs) cause significant morbidity, and current guidelines suggest treatment with parenteral antibiotics for 4-6 weeks. However, utility of oral antibiotics as a potential alternative has yet to be thoroughly investigated. To provide a statistical appraisal of literature comparing treatment success and complication rates of oral antibiotics to parenteral antibiotics for BJIs.

Methods: PubMed, Embase, Cochrane, and Web of Science databases were queried for studies published by November 12, 2024. Randomized controlled trials (RCTs) comparing parenteral to oral regimens for the entire treatment duration were included, as well as comparative studies evaluating "early switch" therapy, defined as switching from parenteral to oral antibiotics within 28 days. Data was pooled and sub-analyzed according to design (RCTs or early switch cohorts). Treatment successes and complications for parenteral and oral groups were assessed via DerSimonian-Laird binary random-effects modeling with a p-value < 0.05 indicating significance.

Results: Six RCTs (1,310 patients) compared treatment success of parenteral or oral regimens for the duration of the infection treatment, and six retrospective cohort studies (1,106 patients) compared parenteral therapy to early switch therapy. Meta-analysis of RCTs demonstrated no significant difference for treatment success rates for oral versus parenteral antibiotics (OR 1.09 [0.79-1.51], p = 0.93, I² = 0.00%). Six early switch cohort studies demonstrated that oral antibiotics had significantly higher success (OR = 1.70 [1.13-2.54], p = 0.01, I² = 0.00%). Meta-data of both RCTs and early switch cohort studies demonstrated no significant difference in complication rates.

Conclusion: No difference in treatment success rates or complication rates was found when comparing oral and parenteral antibiotics. Oral antibiotics are a possible option for treatment of BJIs.

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与肠外抗生素相比，口服抗生素在治疗骨和关节感染方面显示出相似的成功率和并发症：一项系统综述和荟萃分析。

目的：骨和关节感染（BJIs）引起显著的发病率，目前的指南建议使用肠外抗生素治疗4-6周。然而，口服抗生素作为一种潜在的替代方法的效用尚未得到彻底的调查。目的对比较口服抗生素与非肠外抗生素治疗BJIs的成功率和并发症发生率的文献进行统计评价。方法：检索2024年11月12日前发表的PubMed、Embase、Cochrane和Web of Science数据库。包括在整个治疗期间比较肠外和口服方案的随机对照试验（rct），以及评估“早期转换”治疗的比较研究，定义为在28天内从肠外切换到口服抗生素。根据设计（随机对照试验或早期切换队列）汇总数据并进行细分分析。结果：6项随机对照试验（1310例患者）比较了感染治疗期间肠外治疗或口服治疗方案的治疗成功率，6项回顾性队列研究（1106例患者）比较了肠外治疗和早期转换治疗的效果。随机对照试验的荟萃分析显示口服抗生素与肠外抗生素的治疗成功率无显著差异（OR 1.09 [0.79-1.51], p = 0.93, I2 = 0.00%）。6项早期切换队列研究表明，口服抗生素的成功率显著高于口服抗生素（OR = 1.70 [1.13-2.54], p = 0.01, I2 = 0.00%）。随机对照试验和早期切换队列研究的元数据均显示并发症发生率无显著差异。结论：口服与肠外抗生素治疗成功率及并发症发生率无显著差异。口服抗生素是治疗BJIs的一种可能选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infection 医学-传染病学

CiteScore

12.50

自引率

1.30%

发文量

224

审稿时长

6-12 weeks

期刊介绍： Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings. The journal covers a wide range of topics, including: Etiology: The study of the causes of infectious diseases. Pathogenesis: The process by which an infectious agent causes disease. Diagnosis: The methods and techniques used to identify infectious diseases. Treatment: The medical interventions and strategies employed to treat infectious diseases. Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies. Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections. In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.