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Oral switch vs. continued intravenous antibiotic therapy in patients with bacteraemia and sepsis: a systematic review
Qinyuan Li1, Qi Zhou2, Jiangbo Fan3
1Department of Respiratory Medicine Children's Hospital of Chongqing Medical University, National Clinical Research Centre for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Key Laboratory of Children's Vital Organ Development and Diseases of Chongqing Health Commission, Chongqing, China.
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.
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