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

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BackgroundBacteraemia and sepsis have traditionally required continued intravenous (IV) antibiotics. ObjectivesTo evaluate if early transition to oral antibiotics is noninferior to continued IV antibiotic therapy in treating patients with bacteraemia and sepsis. Data sourcesMEDLINE, Embase, Web of Science, the Cochrane library, and Wanfang databases from inception to July 13, 2024, along with clinical trial registries and Google.com. Study eligibility criteriaRandomised controlled trials (RCTs) and cohort studies. ParticipantsPatients with bacteraemia and sepsis. InterventionsEarly transition to oral antibiotics versus continued IV antibiotics. Early oral switch was defined as 5-9 days for uncomplicated Staphylococcus aureus bacteraemia, <4 weeks for complicated Staphylococcus aureus bacteraemia, 3-7 days for uncomplicated Streptococcus bacteraemia, and 3-5 days for uncomplicated Enterobacterales bacteraemia.Assessment of risk of bias: Cochrane risk of bias tool and Newcastle-Ottawa Scale. Methodsof data synthesis: Random-effects models were used to pool the data. The primary outcome was treatment failure. The non-inferiority margin for treatment failure was 10%. The GRADE approach was used to rate the certainty of the evidence. ResultsIn 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 7,102 patients. High-certainty evidence from six RCTs showed that early transition to oral antibiotics was noninferior to continued IV therapy for treatment failure (n=529; OR 0.89; 95% CI: 0.54 to 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 to 1.72). Moderate-certainty evidence showed that oral switch therapy significantly reduced hospital stay (n=2,041; mean difference: -5.19 days; 95% CI: -8.16 to -2.22). ConclusionsEarly transition to oral antibiotics was noninferior to continued IV antibiotic treatment for bacteraemia and sepsis.