Oral switch vs. continued intravenous antibiotic therapy in patients with bacteraemia and sepsis: A systematic review and meta-analysis

Liu, Qingyuan, Zhou, Qi, Fan, Jiangbo, Huang, Siyuan, Chen, Yaolong, Song, Fujian, Fu, Zhou, Liu, Enmei, Tang, Daolin, Zeng, Ling and Luo, Zhengxiu (2025) Oral switch vs. continued intravenous antibiotic therapy in patients with bacteraemia and sepsis: A systematic review and meta-analysis. Clinical Microbiology and Infection, 31 (4). pp. 551-559. ISSN 1198-743X

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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.

Item Type:	Article
Uncontrolled Keywords:	antibiotic,bacteraemia,meta-analysis,oral therapy,sepsis,switch,microbiology (medical),infectious diseases ,/dk/atira/pure/subjectarea/asjc/2700/2726
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Centres > Population Health
Related URLs:	http://www.scopus.com/inward/record.url?...
Depositing User:	LivePure Connector
Date Deposited:	24 Mar 2025 11:31
Last Modified:	31 Mar 2025 08:30
URI:	https://ueaeprints.uea.ac.uk/id/eprint/98871
DOI:	10.1016/j.cmi.2024.11.035

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