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: To evaluate if early transition to oral antibiotics is noninferior to continued IV antibiotic therapy in treating patients with bacteraemia and sepsis.

Data Sources: MEDLINE, 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 Criteria: Randomised controlled trials (RCTs) and cohort studies.

Participants: Patients with bacteraemia and sepsis.

Interventions: Early 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.

Methods: of 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.

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 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).

Conclusions: Early transition to oral antibiotics was noninferior to continued IV antibiotic treatment for bacteraemia and sepsis.