Imperial College London
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ProfessorGrahamCooke

Faculty of Medicine, Department of Infectious Disease

Vice Dean (Research); Professor of Infectious Diseases
 
 
 
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g.cooke

 
 
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Location

 

Infectious Diseases SectionMedical SchoolSt Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Li:2019:10.1056/nejmoa1710926,
author = {Li, H-K and Rombach, I and Zambellas, R and Walker, AS and McNally, MA and Atkins, BL and Lipsky, BA and Hughes, HC and Bose, D and Kümin, M and Scarborough, C and Matthews, PC and Brent, AJ and Lomas, J and Gundle, R and Rogers, M and Taylor, A and Angus, B and Byren, I and Berendt, AR and Warren, S and Fitzgerald, FE and Mack, DJF and Hopkins, S and Folb, J and Reynolds, HE and Moore, E and Marshall, J and Jenkins, N and Moran, CE and Woodhouse, AF and Stafford, S and Seaton, RA and Vallance, C and Hemsley, CJ and Bisnauthsing, K and Sandoe, JAT and Aggarwal, I and Ellis, SC and Bunn, DJ and Sutherland, RK and Barlow, G and Cooper, C and Geue, C and McMeekin, N and Briggs, AH and Sendi, P and Khatamzas, E and Wangrangsimakul, T and Wong, THN and Barrett, LK and Alvand, A and Old, CF and Bostock, J and Paul, J and Cooke, G and Thwaites, GE and Bejon, P and Scarborough, M},
doi = {10.1056/nejmoa1710926},
journal = {New England Journal of Medicine},
pages = {425--436},
title = {Oral versus intravenous antibiotics for bone and joint infection},
url = {http://dx.doi.org/10.1056/nejmoa1710926},
volume = {380},
year = {2019}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BackgroundThe management of complex orthopedic infections usually includes a prolonged course of intravenous antibiotic agents. We investigated whether oral antibiotic therapy is noninferior to intravenous antibiotic therapy for this indication.MethodsWe enrolled adults who were being treated for bone or joint infection at 26 U.K. centers. Within 7 days after surgery (or, if the infection was being managed without surgery, within 7 days after the start of antibiotic treatment), participants were randomly assigned to receive either intravenous or oral antibiotics to complete the first 6 weeks of therapy. Follow-on oral antibiotics were permitted in both groups. The primary end point was definitive treatment failure within 1 year after randomization. In the analysis of the risk of the primary end point, the noninferiority margin was 7.5 percentage points.ResultsAmong the 1054 participants (527 in each group), end-point data were available for 1015 (96.3%). Treatment failure occurred in 74 of 506 participants (14.6%) in the intravenous group and 67 of 509 participants (13.2%) in the oral group. Missing end-point data (39 participants, 3.7%) were imputed. The intention-to-treat analysis showed a difference in the risk of definitive treatment failure (oral group vs. intravenous group) of −1.4 percentage points (90% confidence interval [CI], −4.9 to 2.2; 95% CI, −5.6 to 2.9), indicating noninferiority. Complete-case, per-protocol, and sensitivity analyses supported this result. The between-group difference in the incidence of serious adverse events was not significant (146 of 527 participants [27.7%] in the intravenous group and 138 of 527 [26.2%] in the oral group; P=0.58). Catheter complications, analyzed as a secondary end point, were more common in the intravenous group (9.4% vs. 1.0%).ConclusionsOral antibiotic therapy was noninferior to intravenous antibiotic therapy when used during the first 6 weeks for complex orthopedic infection, as assessed b
AU  - Li,H-K
AU  - Rombach,I
AU  - Zambellas,R
AU  - Walker,AS
AU  - McNally,MA
AU  - Atkins,BL
AU  - Lipsky,BA
AU  - Hughes,HC
AU  - Bose,D
AU  - Kümin,M
AU  - Scarborough,C
AU  - Matthews,PC
AU  - Brent,AJ
AU  - Lomas,J
AU  - Gundle,R
AU  - Rogers,M
AU  - Taylor,A
AU  - Angus,B
AU  - Byren,I
AU  - Berendt,AR
AU  - Warren,S
AU  - Fitzgerald,FE
AU  - Mack,DJF
AU  - Hopkins,S
AU  - Folb,J
AU  - Reynolds,HE
AU  - Moore,E
AU  - Marshall,J
AU  - Jenkins,N
AU  - Moran,CE
AU  - Woodhouse,AF
AU  - Stafford,S
AU  - Seaton,RA
AU  - Vallance,C
AU  - Hemsley,CJ
AU  - Bisnauthsing,K
AU  - Sandoe,JAT
AU  - Aggarwal,I
AU  - Ellis,SC
AU  - Bunn,DJ
AU  - Sutherland,RK
AU  - Barlow,G
AU  - Cooper,C
AU  - Geue,C
AU  - McMeekin,N
AU  - Briggs,AH
AU  - Sendi,P
AU  - Khatamzas,E
AU  - Wangrangsimakul,T
AU  - Wong,THN
AU  - Barrett,LK
AU  - Alvand,A
AU  - Old,CF
AU  - Bostock,J
AU  - Paul,J
AU  - Cooke,G
AU  - Thwaites,GE
AU  - Bejon,P
AU  - Scarborough,M
DO  - 10.1056/nejmoa1710926
EP  - 436
PY  - 2019///
SN  - 0028-4793
SP  - 425
TI  - Oral versus intravenous antibiotics for bone and joint infection
T2  - New England Journal of Medicine
UR  - http://dx.doi.org/10.1056/nejmoa1710926
UR  - http://hdl.handle.net/10044/1/67586
VL  - 380
ER  -
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