Early switch to oral antibiotic therapy for the treatment of patients with bacterial native vertebral osteomyelitis: a quaternary center experience, systematic review, and meta-analysis

Abstract

Abstract. Recent data suggest that oral therapy can be effective for bone infections. We aim to assess the efficacy of an early switch to oral therapy (<2 weeks) compared to a non-early switch in bacterial native vertebral osteomyelitis. We conducted a cohort study at Mayo Clinic, Rochester (MN), between 2019–2021 combined with a systematic review, which queried multiple databases. Data were analyzed using a random-effects model. The cohort study included 139 patients: two received an early switch. Of 3708 citations, 13 studies were included in the final analysis. Meta-analysis demonstrated no difference in treatment failure (odds ratio = 1.073, 95 % confidence interval 0.370–3.116), but many studies presented high risk of bias. Current evidence is insufficient to conclude the proportion of patients with failure or relapse is different in the two groups. High-quality studies are warranted before early switch can be routinely recommended.

Systemic Antimicrobial Treatment of Chronic Osteomyelitis in Adults: A Narrative Review

“…The meta-analysis of seven observational comparative studies did not have enough evidence to show a higher efficacy of either group. Within the observational studies the authors determined high risk of bias due to differences in demographics, comorbidities, and other confounders between the patients in the two arms [ 11 ].…”

“…There has been growing interest in exploring the role of oral antibiotic therapy or short-term parenteral therapy followed by oral antibiotics as a potential outpatient management option for chronic osteomyelitis [ 10 , 11 ]. Due to vascular impairment, it is a therapeutic challenge to deliver pharmaceutical agents to the site of osteitis [ 47 , 48 ].…”

“…An oral approach may offer advantages in terms of reduced hospitalisation duration, improved patient convenience, and potentially lower healthcare costs [ 25 , 26 , 49 ], with no statistically significant cure rates between oral and parenteral therapy [ 49 ]. However, the efficacy, safety, and optimal selection of patients for this approach compared to traditional parenteral antibiotic therapy require further investigation [ 1 , 11 ]. Local antibiotic delivery systems present an interesting alternative in osteomyelitis treatment.…”

“…Secondly, the role of oral antibiotic therapy remains a topic of debate. Oral antibiotics or short-term parenteral therapy followed by oral antibiotics are a potential management option for chronic osteomyelitis and could provide an alternative to parenteral therapy alone [ 10 , 11 ]. Finally, rifampicin is often considered as an adjunctive treatment option for chronic osteomyelitis, especially when caused by Staphylococcus aureus [ 12 ].…”

Switching from intravenous vancomycin to oral antibiotics reduces adverse events in a retrospective cohort of outpatients with orthopedic infections

“…[2][3][4][5] However, the drawbacks of intravenous (IV) antibiotics include cost, barriers to coordinating and managing outpatient IV therapy, risk of IV line complications, and the considerable risk of toxicity from commonly used IV antibiotics, in particular vancomycin. 6 Despite numerous studies indicating that oral (PO) antibiotics are as effective as IV antibiotics for the treatment of orthopedic infections, [7][8][9][10][11][12][13][14][15] including a large randomized clinical trial, 14 clinicians in the United States (US) remain reluctant to use PO antibiotics for the treatment of these serious infections. 16,17 One possible explanation for this reluctance is that the most robust evidence for the equivalence of PO and IV antibiotics comes from a randomized clinical trial in the United Kingdom (the OVIVA trial), which included only a small number of patients (N = 19) with methicillin-resistant Staphylococcus aureus (MRSA).…”