Antibiotic Route of Administration: Is Oral the New IV in Older Adults?

Background Oral therapy is widely used to treat many infections. However, there is less consensus regarding the use of oral antibiotics for serious infections. Objective This review aims to evaluate randomized controlled trials (RCTs) comparing intravenous and oral antibiotic treatments for osteomyelitis, endocarditis, and bacteremia, with a particular emphasis on data pertaining to older adults. Data Source A list of RCTs comparing intravenous and oral antibiotics for these types of infections was compiled through a search of PubMed and EMBASE. Data Synthesis A total of 19 RCTs were identified, including nine for osteomyelitis, three for endocarditis, six for bacteremia, and one addressing both osteomyelitis and bacteremia. All trials reported no significant difference between intravenous and oral antibiotic treatments. The inclusion of older adults varied across infection types. For osteomyelitis, only three of the ten RCTs had a mean patient age of 60 years or older. For endocarditis, two of the three RCTs had a mean patient age of 60 years or older. Lastly, for bacteremia, four of the seven RCTs had a mean patient age of 60 years or older. Discussion All retrieved RCTs support the use of fully or partially oral antibiotic regimens for osteomyelitis, endocarditis, and bacteremia. Although data support the use of oral antibiotics in older adults for all three infection types, the number of trials that included older adults varied. Conclusions Several RCTs support the use of fully or partially oral antibiotic regimens for osteomyelitis, endocarditis, and bacteremia. Oral agents may be reasonable options for older adults, depending on an individual's benefit-to-risk assessment.