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Oral vs IV antibiotics Therapeutics Initiative (University of British Columbia)

Description

Background: Many clinicians perceive intravenous (IV) antibiotics as inherently more effective than their oral counterparts. However, randomized controlled trials (RCTs) have demonstrated that oral antibiotics are clinically equivalent to IV antibiotics for many severe bacterial infections. This includes pneumonia, skin and soft tissue infections, pyelonephritis, intra-abdominal infections, osteoarticular infections, bacteremia, and infective endocarditis. When clinically appropriate, oral treatment is more patient-friendly, cost-effective, and environmentally friendly. But we still use the IV route much more than necessary. Aim: To address a historical practice that is often unwarranted, Therapeutics Letter 155 reviews evidence from RCTs and compares the advantages and disadvantages of oral and IV antibiotics. We suggest criteria to determine when oral therapy is appropriate. Recommendations: ▪ For most stable patients, oral antibiotics should be the standard of care. ▪ Reserve IV therapy for critically ill patients and situations where oral administration is not possible, or is not supported by evidence. ▪ In patients initially prescribed IV treatment, convert to oral therapy as soon as clinically appropriate.

Item Metadata

Title
Oral vs IV antibiotics
Alternate Title
Therapeutics Letter 155
Creator
Therapeutics Initiative (University of British Columbia)
Date Issued
2025-05
Description
Background: Many clinicians perceive intravenous (IV) antibiotics as inherently more effective than their oral counterparts. However, randomized controlled trials (RCTs) have demonstrated that oral antibiotics are clinically equivalent to IV antibiotics for many severe bacterial infections. This includes pneumonia, skin and soft tissue infections, pyelonephritis, intra-abdominal infections, osteoarticular infections, bacteremia, and infective endocarditis. When clinically appropriate, oral treatment is more patient-friendly, cost-effective, and environmentally friendly. But we still use the IV route much more than necessary. Aim: To address a historical practice that is often unwarranted, Therapeutics Letter 155 reviews evidence from RCTs and compares the advantages and disadvantages of oral and IV antibiotics. We suggest criteria to determine when oral therapy is appropriate. Recommendations: ▪ For most stable patients, oral antibiotics should be the standard of care. ▪ Reserve IV therapy for critically ill patients and situations where oral administration is not possible, or is not supported by evidence. ▪ In patients initially prescribed IV treatment, convert to oral therapy as soon as clinically appropriate.
Subject
Anti-Bacterial Agents; Bacterial Infections; Cost-Benefit Analysis; Drug Administration Routes; Drug-Related Side Effects and Adverse Reactions; Inappropriate Prescribing; Intravenous Administration; Oral Administration; Treatment Outcome
Genre
Other
Type
Text
Language
eng
Notes
The UBC TI is funded by the BC Ministry of Health to provide evidence-based information about drug therapy. We neither formulate nor adjudicate provincial drug policies.
Date Available
2025-05-26
Provider
Vancouver : University of British Columbia Library
Rights
Attribution-NonCommercial-NoDerivatives 4.0 International
DOI
10.14288/1.0448946
URI
http://hdl.handle.net/2429/91191
Affiliation
Medicine, Faculty of; Anesthesiology, Pharmacology and Therapeutics, Department of
Peer Review Status
Reviewed
Scholarly Level
Faculty; Researcher
Rights URI
http://creativecommons.org/licenses/by-nc-nd/4.0/
Aggregated Source Repository
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Attribution-NonCommercial-NoDerivatives 4.0 International