Outpatients with acute osteoarticular infections had favourable outcomes when they received just oral antibiotics without intravenous antibiotics

Abstract Purpose: Our aim was to investigate the clinical efficacy and complications of antibiotics treatment duration for the patients of bone infection. Methods: We retrospectively analyzed the patients with bone infection admitted to our hospital between March 2013 and October 2018. The surgical debridement was performed and the patients were divided into three groups: IV group (Intravenous antibiotics for 2 weeks); Oral group (Intravenous antibiotics for 2 weeks followed by oral antibiotics for 4 weeks); Rifampicin group (Intravenous antibiotics for 2 weeks followed by oral antibiotics plus rifampicin for 4 weeks). The infection control rate and complications were compared. Results ： A total of 902 patients were enrolled, the infection sites included 509 tibias, 228 femurs, 32 humeri, 23 radii and ulnae, 40 calcanei, 23 multiple-site infections and the other sites 47 cases. After at least 6 months of follow-up, 148 (16.4%) patients had recurrence of infection. The recurrence rate of IV group was 17.9%, which was no significant higher than that of Oral group (10.1%) or Rifampicin group (10.5%). The abnormal rate of Glutamic-pyruvic transaminase(ALT) in IV group was 15.1%, which was lower than that of Oral group (18.0%) and Rifampicin group (27.4%), P=0.026. The positive rates of proteinuria in the three groups were 3.2%, 4.5%, and 9.3%, respectively, P=0.020. Conclusion: After debridement of bone infection, the additional oral antibiotic treatment may increase the damage of liver and kidney, and can not significantly reduce the infection recurrence rate. Therefore, it is recommended to adopt short-term systemic antibiotic treatment after debridement.

Download Full-text

Sequential Intravenous High Dose Oral Antibiotics in the Treatment of Osteoarticular Infections in Children: A Randomized Controlled Trial

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw172.827 ◽

2016 ◽

Vol 3 (suppl_1) ◽

Author(s):

Karen Tsui ◽

Haemish Crawford ◽

Florina Chan Mow ◽

Rachel Webb ◽

Lesley M. Voss ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

High Dose ◽

Oral Antibiotics ◽

Randomized Controlled ◽

Osteoarticular Infections ◽

Dose Oral

Download Full-text

Favorable Outcomes With Early Transition to Oral Antibiotics for Pediatric Osteoarticular Infections

Clinical Pediatrics ◽

10.1177/0009922819829041 ◽

2019 ◽

Vol 58 (6) ◽

pp. 696-699 ◽

Cited By ~ 2

Author(s):

Shamim Islam ◽

Nora Biary ◽

Brian Wrotniak

Keyword(s):

Oral Antibiotics ◽

Osteoarticular Infections ◽

Early Transition

Download Full-text

EP.TH.965Use of Oral Antibiotics as Adjunct to Systemic Antibiotics and Mechanical Bowel Preparation for Left Sided Colorectal Surgery. It is the time to trust the best available evidence and change the practice

British Journal of Surgery ◽

10.1093/bjs/znab309.100 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Shahin Hajibandeh ◽

Shahab Hajibandeh ◽

Christopher Thompson ◽

Vijay Thumbe ◽

Andrew Torrance ◽

...

Keyword(s):

Colorectal Surgery ◽

Anastomotic Leak ◽

Bowel Preparation ◽

Mechanical Bowel Preparation ◽

Surgical Site Infections ◽

Oral Antibiotics ◽

Intravenous Antibiotics ◽

Clinically Significant ◽

The Uk ◽

Systemic Antibiotics

Abstract Aims To prospectively evaluate the clinical efficacy of oral antibiotics as an adjunct to intravenous antibiotics and mechanical bowel preparation (MBP) in patients undergoing left sided colorectal surgery. Methods All participants aged 18 years or older and of any gender undergoing an elective open or laparoscopic left sided colorectal resection for benign or malignant colorectal pathologies were considered. The intervention of interest was oral neomycin 1g every 4 hours combined with oral metronidazole 400mg every 8 hours from 24 hours before the proposed surgery. Surgical site infections (SSIs), anastomotic leak, paralytic ileus, need for intervention, and mortality were the evaluated outcome parameters. Results Forty-two consecutive patients received oral antibiotics as an adjunct to intravenous antibiotics and MBP before left sided colorectal surgery. The mean age was 58.8 ± 11.5. There were 23 males (54.8%) and 19 females (45.2%). Use of oral antibiotics was associated with SSI infection rate of 2.4% (1 patient). The rates of clinically significant and non-significant anastomotic leak were 0% and 2.9%, respectively. Moreover, postoperative ileus happened in 11.9% of patients. Furthermore, there was no mortality or need for re-intervention. Conclusions Use of oral antibiotics as an adjunct to intravenous antibiotics and MBP in patients undergoing left-sided colorectal surgery was associated with a surprisingly low rate of SSIs and no significant anastomotic leak. It is time to trust the best available evidence and incorporate the use of oral antibiotics as an adjunct to intravenous antibiotics and MBP in colorectal surgery protocols in the UK hospitals.

Download Full-text

Usefulness of Preoperative Mechanical Bowel Preparation in Patients with Colon Cancer who Undergo Elective Surgery: A Prospective Randomized Trial Using Oral Antibiotics

Digestive Surgery ◽

10.1159/000500020 ◽

2019 ◽

Vol 37 (3) ◽

pp. 192-198 ◽

Cited By ~ 2

Author(s):

Toshiyuki Suzuki ◽

Sotaro Sadahiro ◽

Akira Tanaka ◽

Kazutake Okada ◽

Gota Saito ◽

...

Keyword(s):

Colon Cancer ◽

Bowel Preparation ◽

Elective Surgery ◽

Mechanical Bowel Preparation ◽

Infectious Complications ◽

Oral Antibiotic ◽

Oral Antibiotics ◽

Intravenous Antibiotics ◽

Colon Cancer Surgery ◽

To Receive

Background: To prevent surgical site infection (SSI) in colorectal surgery, the combination of mechanical bowel preparation (MBP), oral antibiotic bowel preparation (OABP), and the intravenous antibiotics have been proposed as standard treatment. We conducted an RCT comparing the incidence of SSI between MBP + OABP and OABP alone after receiving a single dose of intravenous antibiotics. Methods: The study group comprised 254 patients who underwent elective surgery for colon cancer. Patients were randomly assigned to receive MBP + OABP and intravenous antibiotics (MBP + OABP group) or to receive OABP and intravenous antibiotics (OABP alone group). Results: Overall, 125 patients in MBP + OABP group and 126 patients in OABP alone group were eligible. Incisional SSI occurred in 3 patients (2.4%) in MBP + OABP group, and 8 patients (6.3%) in the OABP-alone group. Organ/space SSI developed in 0 patients (0%) and in 4 patients (3.2%) in each group respectively. The OABP-alone group was thus not shown to be noninferior to the MBP + OABP group in the incidences of incisional SSI or organ/space SSI. Other infectious complications developed in 7 patients (5.6%) and in 6 patients (4.8%) in each group, indicating the non-inferiority of OABP alone to MBP + OABP. Conclusions: MBP combined with oral antibiotics and intravenous antibiotics remains standard in elective colon cancer surgery.

Download Full-text

Oral vs Intravenous Antibiotics for Patients With Klebsiella pneumoniae Liver Abscess: A Randomized, Controlled Noninferiority Study

Clinical Infectious Diseases ◽

10.1093/cid/ciz881 ◽

2019 ◽

Vol 71 (4) ◽

pp. 952-959 ◽

Cited By ~ 2

Author(s):

James S Molton ◽

Monica Chan ◽

Shirin Kalimuddin ◽

Jolene Oon ◽

Barnaby E Young ◽

...

Keyword(s):

Klebsiella Pneumoniae ◽

Clinical Response ◽

Liver Abscess ◽

Primary Endpoint ◽

Risk Difference ◽

Oral Antibiotics ◽

Serious Adverse Events ◽

Metastatic Infection ◽

Intravenous Antibiotics ◽

Oral Ciprofloxacin

Abstract Background Klebsiella pneumoniae liver abscess (KLA) is emerging worldwide due to hypermucoviscous strains with a propensity for metastatic infection. Treatment includes drainage and prolonged intravenous antibiotics. We aimed to determine whether oral antibiotics were noninferior to continued intravenous antibiotics for KLA. Methods This noninferiority, parallel group, randomized, clinical trial recruited hospitalized adults with liver abscess and K. pneumoniae isolated from blood or abscess fluid who had received ≤7 days of effective antibiotics at 3 sites in Singapore. Patients were randomized 1:1 to oral (ciprofloxacin) or intravenous (ceftriaxone) antibiotics for 28 days. If day 28 clinical response criteria were not met, further oral antibiotics were prescribed until clinical response was met. The primary endpoint was clinical cure assessed at week 12 and included a composite of absence of fever in the preceding week, C-reactive protein <20 mg/L, and reduction in abscess size. A noninferiority margin of 12% was used. Results Between November 2013 and October 2017, 152 patients (mean age, 58.7 years; 25.7% women) were recruited, following a median 5 days of effective intravenous antibiotics. A total of 106 (69.7%) underwent abscess drainage; 71/74 (95.9%) randomized to oral antibiotics met the primary endpoint compared with 72/78 (92.3%) randomized to intravenous antibiotics (risk difference, 3.6%; 2-sided 95% confidence interval, −4.9% to 12.8%). Effects were consistent in the per-protocol population. Nonfatal serious adverse events occurred in 12/72 (16.7%) in the oral group and 13/77 (16.9%) in the intravenous group. Conclusions Oral antibiotics were noninferior to intravenous antibiotics for the early treatment of KLA. Clinical Trials Registration NCT01723150.

Download Full-text