Early switch from intravenous to oral antibiotic treatment in bone and joint infections

Abstract

Objectives: The timing of the switch from intravenous (i.v.) to oral antibiotic therapy for orthopaedic bone and joint infections (BJIs) is debated. In this narrative article, we discuss the evidence for and against an early switch in BJIs.

Data sources: We performed a PubMed and internet search investigating the association between the duration of i.v. treatment for BJI and remission of infection among adult orthopaedic patients.

Content: Among eight randomized controlled trials and multiple retrospective studies, we failed to find any minimal duration of postsurgical i.v. therapy associated with clinical outcomes. We did not find scientific data to support the prolonged use of i.v. therapy or to inform a minimal duration of i.v.

Therapy: Growing evidence supports the safety of an early switch to oral medications once the patient is clinically stable.

Implications: After surgery for BJI, a switch to oral antibiotics within a few days is reasonable in most cases. We recommend making the decision on the time point based on clinical criteria and in an interdisciplinary team at the bedside.

Keywords: Bone and joint infections; Oral antimicrobial therapy; Orthopaedic device-related infection; Osteomyelitis; Septic arthritis.