Oral antibiotics may be noninferior to IV antibiotics for fracture-related infection
Key takeaways:
- Oral antibiotics may be noninferior to IV antibiotics for treatment of fracture-related infection.
- The interventions yielded a similar number of surgical interventions required within 1 year.
Published results showed oral antibiotics may be noninferior to IV antibiotics with respect to number of surgical interventions required within 1 year for patients with fracture-related infections.
“This study adds to the literature that the route of administration of antibiotics is less important than previously believed,” William T. Obremskey, MD, MOH, MMHC, professor in the division of orthopedic trauma and director of orthopedic trauma research at Vanderbilt University Medical Center, told Healio. “More patients may be eligible to receive antibiotics by mouth, and thus decrease the need of a central line for IV antibiotics and concerns for line clotting and infections, as well as [have] decreased cost and improved convenience.”
Obremskey and colleagues from the Major Extremity Trauma Research Consortium randomly assigned 233 patients (mean age, 46 years) who developed a fracture-related infection after fracture repair or arthrodesis and did not have radiographic evidence of osteomyelitis to receive either oral (n = 115) or IV (n = 118) antibiotics. Randomization occurred between March 2013 and September 2018 across 24 U.S. trauma centers, and patients had 1 year of follow-up.
The mean number of surgical interventions within 1 year was 1.32 for the oral antibiotics group. It was 1.09 for the IV antibiotics group.
After unadjusted modified intent-to-treat (mITT) analysis, Obremskey and colleagues found a mean difference of 0.59 between the oral and IV groups. The mean difference was lower than the prespecified noninferiority margin of 0.67, which demonstrated noninferiority for oral antibiotics vs. IV antibiotics. Obremskey and colleagues found a similar pattern of inferiority when comparing reinfection rates for oral antibiotics vs. IV antibiotics.
In addition, Obremskey and colleagues found adjusted mITT analysis demonstrated noninferiority for oral antibiotics vs. IV antibiotics. However, they found adjusted per-protocol analysis did not demonstrate noninferiority for oral antibiotics vs. IV antibiotics.
“Clinicians and patients can use these data to inform shared decision-making regarding antibiotic care for fracture-related infections,” Obremskey and colleagues wrote in the study.
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