TOPLINE:

In children with bone and joint infections (BJIs), early switching from intravenous (IV) to oral antibiotics demonstrated comparable safety and effectiveness to prolonged IV treatment, while reducing hospital stay and IV-related complications.

METHODOLOGY:

• Researchers conducted a systematic review and meta-analysis to examine whether early switching from IV to oral antibiotics is safe in children with BJIs, without compromising clinical outcomes.
• They included 24 studies comprising 7881 participants (age, 0-18 years), with 3049 children in the early oral switch group and 4832 children in the prolonged IV therapy group.
• Primary outcomes were safety and effectiveness, assessed by comparing complication rates between the treatment strategies.

TAKEAWAY:

• Early transition to oral therapy demonstrated comparable safety and effectiveness to prolonged IV treatment (risk ratio, 0.82; P = .20), with no significant difference in complication rates observed between the two groups.
• Switching to oral antibiotics after fewer than 5 days of IV therapy was not associated with an increased risk for complications, with complication rates trending in favour of earlier oral treatment.
• Children receiving oral or shorter IV therapy had shorter hospital stays (median length, 1-6 days), and 12.8% of those on prolonged IV therapy had reduced peripherally inserted central catheter-related complications, ranging from minor local skin infections to severe bloodstream infection and sepsis.
• Early transition to oral antibiotics was equally effective across all infection types, including osteomyelitis, septic arthritis, and combined infections.

IN PRACTICE:

"[The study] findings support the implementation of evidence-based protocols to guide early switch decisions, emphasizing clinical improvement, laboratory response, and pathogen characteristics and epidemiology," the authors wrote.

SOURCE:

This study was led by Argyro Konstantopoulou and Maria Maroudia Berikopoulou, "Aghia Sophia" Children's Hospital, Athens, Greece. It was published online on March 30, 2026, in the European Journal of Pediatrics.

LIMITATIONS:

Most included studies were observational or retrospective, introducing potential selection bias and confounding by indication. The IV therapy of fewer than 5 days was exploratory and limited by heterogeneity. Combined reporting of infection types may have obscured condition‑specific treatment effects.

DISCLOSURES:

This study did not receive any specific funding. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.