In the largest trial of its kind, patients receiving oral versus intravenous (IV) antibiotics for fracture-related infections (FRIs) had similar reoperation and reinfection rates, US researchers reported this week in JAMA Surgery.. But the primary and secondary analyses of trial results came to different conclusions regarding noninferiority, leaving some uncertainty about the findings.

Oral dosing of omadacyline or linezolid was found equally efficacious to intravenous administration in treating acute bacterial skin and skin structure infections (ABSSSI) in a post hoc analysis of two trials that compared safety and efficacy of the 2 antibiotics. 1 "Oral therapy can reduce the need for hospitalization or the length of stay for patients who are admitted, which are major ...

Examples of IV antibiotics that might be selected include: ertapenem, piperacillin-tazobactam, fluoroquinolones like ciprofloxacin or levofloxacin, gentamicin, tobramycin, ceftriaxone, and cefepime, among others. Choices depend upon severity of illness and risk for multidrug resistance.

The patient had been started on intravenous daptomycin before surgical debridement and intravenous ciprofloxacin was added postoperatively when culture results became available to cover for P. aeruginosa. Phage therapy was administered via the two drains three times a day, for a total of four days post-surgery followed by removal of the drains.

Importance: Fracture-related infection (FRI) is a serious complication following fracture fixation surgery. Current treatment of FRIs entails debridement and 6 weeks of intravenous (IV) antibiotics. Lab data and retrospective clinical studies support use of oral antibiotics, which are less expensive and may have fewer complications than IV antibiotics.