Abstract
Background: Bacteraemia and sepsis have traditionally required continued intravenous (IV) antibiotics.
Objectives: This study aims to evaluate if early transition to oral antibiotics is non-inferior to continued IV antibiotic therapy in treating patients with bacteraemia and sepsis.
Data sources: Data sources include MEDLINE, Embase, Web of Science, the Cochrane Library, and Wanfang databases from inception to 13 July 2024, along with clinical trial registries and Google.com.
Study eligibility criteria: Study eligibility criteria include randomized controlled trials (RCTs) and cohort studies.
Participants: Participants include patients with bacteraemia and sepsis.
Interventions: Interventions include early transition to oral antibiotics vs. continued IV antibiotics. Early oral switch was defined as 5–9 days for uncomplicated Staphylococcus aureus bacteraemia, <4 weeks for complicated S. aureus bacteraemia, 3–7 days for uncomplicated Streptococcus bacteraemia, and 3–5 days for uncomplicated Enterobacterales bacteraemia.
Assessment of risk of bias: Assessment of risk of bias includes Cochrane risk of bias tool and Newcastle-Ottawa Scale.
Methods of data synthesis: Random-effect models were used to pool the data. The primary outcome was treatment failure. The non-inferiority margin for treatment failure was 10%. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to rate the certainty of the evidence.
Results: In total, 38 studies (6 RCTs, 10 adjusted cohorts, and 22 unadjusted cohorts) involving 11 566 patients were included. A primary analysis of 6 RCTs and 10 adjusted cohorts comprised 7102 patients. High-certainty evidence from six RCTs showed that early transition to oral antibiotics was non-inferior to continued IV therapy for treatment failure (n = 529; OR 0.89; 95% CI: 0.54–1.48). Low-certainty evidence from five adjusted cohorts also found no significant difference in treatment failure between the two groups (n = 929; OR 0.60; 95% CI: 0.29–1.72). Moderate-certainty evidence showed that oral switch therapy significantly reduced hospital stay (n = 2041; mean difference: –5.19 days; 95% CI: –8.16 to –2.22).
Conclusions: Early transition to oral antibiotics was non-inferior to continued IV antibiotic treatment for bacteraemia and sepsis.
Objectives: This study aims to evaluate if early transition to oral antibiotics is non-inferior to continued IV antibiotic therapy in treating patients with bacteraemia and sepsis.
Data sources: Data sources include MEDLINE, Embase, Web of Science, the Cochrane Library, and Wanfang databases from inception to 13 July 2024, along with clinical trial registries and Google.com.
Study eligibility criteria: Study eligibility criteria include randomized controlled trials (RCTs) and cohort studies.
Participants: Participants include patients with bacteraemia and sepsis.
Interventions: Interventions include early transition to oral antibiotics vs. continued IV antibiotics. Early oral switch was defined as 5–9 days for uncomplicated Staphylococcus aureus bacteraemia, <4 weeks for complicated S. aureus bacteraemia, 3–7 days for uncomplicated Streptococcus bacteraemia, and 3–5 days for uncomplicated Enterobacterales bacteraemia.
Assessment of risk of bias: Assessment of risk of bias includes Cochrane risk of bias tool and Newcastle-Ottawa Scale.
Methods of data synthesis: Random-effect models were used to pool the data. The primary outcome was treatment failure. The non-inferiority margin for treatment failure was 10%. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to rate the certainty of the evidence.
Results: In total, 38 studies (6 RCTs, 10 adjusted cohorts, and 22 unadjusted cohorts) involving 11 566 patients were included. A primary analysis of 6 RCTs and 10 adjusted cohorts comprised 7102 patients. High-certainty evidence from six RCTs showed that early transition to oral antibiotics was non-inferior to continued IV therapy for treatment failure (n = 529; OR 0.89; 95% CI: 0.54–1.48). Low-certainty evidence from five adjusted cohorts also found no significant difference in treatment failure between the two groups (n = 929; OR 0.60; 95% CI: 0.29–1.72). Moderate-certainty evidence showed that oral switch therapy significantly reduced hospital stay (n = 2041; mean difference: –5.19 days; 95% CI: –8.16 to –2.22).
Conclusions: Early transition to oral antibiotics was non-inferior to continued IV antibiotic treatment for bacteraemia and sepsis.
| Original language | English |
|---|---|
| Pages (from-to) | 551-559 |
| Number of pages | 9 |
| Journal | Clinical Microbiology and Infection |
| Volume | 31 |
| Issue number | 4 |
| Early online date | 15 Mar 2025 |
| DOIs | |
| Publication status | Published - Apr 2025 |
Keywords
- Antibiotic
- Bacteraemia
- Meta-analysis
- Oral therapy
- Sepsis
- Switch