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A MULTI-CENTRE UK RANDOMISED OPEN LABEL TRIAL COMPARING ORAL ANTIBIOTIC TREATMENT WITH INTRAVENOUS THERAPY FOR BONE AND JOINT INFECTIONS REQUIRING PROLONGED ANTIBIOTIC TREATMENT

Status: Complete

Number Participants: 1,054

Number Centres: 26

Registration:  ISRCTN91566927 ; NCT00974493

Funding: NIHR Health Technology Assessment Programme

A long course of antibiotic therapy given intravenously (i.e., by injection or via a ‘drip’) is the recommended treatment for many serious bone and joint infections. It is costly and inconvenient for the patient to remain in hospital for treatment, so outpatient antibiotic therapy (OPAT) programs have been established in many centres to deliver intravenous antibiotics safely and conveniently. Most patients referred to OPAT programs have bone and joint infections. However, there was no clear evidence that bone and joint infections really required long courses of intravenous antibiotics rather than oral antibiotics (tablets).

We compared the outcome of treatment with intravenous and oral antibiotic therapy for patients with bone and joint infection. We found that there was no difference up to a year after treatment when the participants were treated with antibiotics delivered by either tablets or a drip during the first 6 weeks of therapy for complex orthopaedic infections. We also found that the patients who received tablets had a shorter length of stay in hospital and they had fewer complications than the patients who received their antibiotics through a drip.

This is great news for patients, for clinical practice and for the health economy.

 

Main contact: Matthew.Scarborough@ouh.nhs.uk

 

Publications:

Oral versus Intravenous Antibiotics for Bone and Joint Infection. Li HK et al. N Engl J Med. (2019) 31;380(5):425-436

 

Oral versus intravenous antibiotics for bone and joint infections: the OVIVA non-inferiority RCT. Scarborough M et al. Health Technol Assess. (2019) 23(38):1-92

 

Cost-effectiveness of oral versus intravenous antibiotics (OVIVA) in patients with bone and joint infection: evidence from a non-inferiority trial. McMeekin N et al. Wellcome Open Research (2019) 4:108-129

 

Oral versus intravenous antibiotic treatment for bone and joint infections (OVIVA): study protocol for a randomised controlled trial. Li HK et al.  Trials. (2015) 21;16:583