Oral versus intravenous antibiotics for bone and joint infections: Systematic review and meta-analysis of randomized...

Recent trials suggest oral (PO) antibiotics may be as effective as prolonged intravenous (IV) regimens in specific clinical scenarios. This meta-analysis compared PO and IV antibiotic therapy in bone and joint infections.

PubMed, Embase and CENTRAL databases were searched for published trials from inception until February 2025 for randomized clinical trials (RCTs) that enrolled patients of any age with confirmed bone and/or joint infections compared oral versus intravenous antibiotic therapy and reported at least one of the prespecified outcomes.

Nine RCTs (1723 patients) published from 1987 to 2025 were included. PO and IV therapies showed comparable efficacy in treatment failure (RR 0.96; 95 % CI 0.78-1.17; p = 0.68; I² = 0 %) and adverse events (RR 1.00; 95 % CI 0.90-1.12; I² = 10 %; p = 0.94). Overall, recurrence rates were similar. However, a subgroup analysis excluding fracture-related infections favored IV therapy (RR 1.47; 95 % CI 1.08-2.02; I² = 0 %; p = 0.02). Superinfection rates showed no difference (RR 1.12; 95 % CI 0.32-3.98; I² = 0 %; p = 0.86). Although not statistically significant, hospitalization duration may be shorter with PO therapy (MD -5.03 days; 95 % CI -15.84-5.77; I² = 4 %; p = 0.36).

Appropriately selected PO antibiotic regimens demonstrate comparable efficacy and safety to IV therapy in bone and joint infections, although there is a slight tendency to increase the recurrence of infections. These findings support a shift toward oral therapy in carefully chosen patients.