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

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.