Pills are just as effective as intravenous (IV) injections in tackling bone infections, a study led by Oxford-based researchers has found.
The findings, published on 30 January in The New England Journal of Medicine, challenge the long-held belief that injections into the vein are the best way to give antibiotics for bone and joint infections, such as infected hip or knee replacements.
They raise hopes that patients could go home sooner, reducing NHS costs.
The study, led by Oxford University Hospitals (OUH) NHS Foundation Trust and supported by the National Institute for Health Research Oxford Biomedical Research Centre, recruited more than 1,000 people with bone or joint infection and randomly allocated them to injection or tablet antibiotics. In most cases, patients underwent surgery as well.
Bone and joint infections, which are commonly caused by bacteria such as staphylococcus (including MRSA) and streptococcus, are often painful, protracted and disabling.
As well as the inconvenience for patients having to stay in hospital or relying on a specialist nurse to visit the patient at home to administer intravenous antibiotics, injections pose a risk to patients as they can be complicated by infection or blood clots.
The study at 26 UK hospitals found little difference in the failure rate of antibiotics between pills or injections given for the first six weeks of treatment.
It found the median length of stay in hospital was 14 days for injections and 11 days for people who took the antibiotics in pill form.
Complications were less common in patients treated by tablets and the treatment costs were £2,740 cheaper than injections.
Chief investigator Dr Matthew Scarborough, OUH Consultant in Infectious Diseases and General Medicine, said: “For decades bone and joint infections have been treated primarily through intravenous antibiotics. This is inconvenient for the patient and costly for the health service.
“Our results are good news for the NHS as use of tablet antibiotics will save money whilst helping to prevent antibiotic resistance. It’s also great news for patients because we now know that changing how we give antibiotics can reduce risk, improve safety and give people more control over their treatment.”
The trial was supported by the NIHR Local Clinical Research network for Thames Valley and South Midlands, and involved staff from the University of Oxford’s Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), as well as members of OUH’s infectious diseases and orthopaedic departments.