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Oral or intravenous antibiotics for complex orthopaedic infections?

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Review of: Li HK, Rombach I, Zambellas R, et al. Oral versus intravenous antibiotics for bone and joint infection. N Engl J Med 2019;380:425–36.

Key learning points

  • Intravenous antibiotics have long been regarded as superior to oral antibiotics for treating complex bone and joint infections.

  • This trial compared treatment failure rates at 1 year for intravenous and oral antibiotic regimens for orthopaedic infections.

  • Oral antibiotics were non-inferior to intravenous antibiotics with no difference in the rate of serious adverse events between regimens.

  • Patients who had oral antibiotics had fewer intravenous-related catheter complications and shorter hospital stays.

For the management of complex bone infections, treatment with oral antibiotics was non-inferior to intravenous antibiotics based on treatment failure rates assessed after 1 year and was associated with a shorter stay in hospital.1


This open-label parallel group randomised controlled non-inferiority trial ('Oral versus Intravenous Antibiotics for bone and joint Infection' [OVIVA]) compared oral and …

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  • Contributors DTB Team.

  • Provenance and peer review Commissioned; internally peer reviewed.