Meta-analysis finds no significant complication difference with early oral antibiotics for pediatric bone infections

UNLABELLED: Bone and joint infections (BJIs) cause significant morbidity, but guidelines remain inconsistent on when to switch from intravenous (IV) to oral antibiotic therapy. This study aims to assess the effectiveness of early transition to oral antibiotics compared to prolonged IV treatment in children with BJIs. A systematic search was conducted in PubMed, Scopus, and Web of Science. The studies that compared early transition to oral treatment in osteoarticular infections in children were included. Data were pooled and analyzed using random- and fixed-effects models. Twenty-four studies (7881 participants) were included. There was no significant difference in complications between children with shorter versus prolonged intravenous therapy. The pooled risk ratio (RR) for complications was 0.82 (95% CI 0.62-1.08; p = 0.2) in the random-effects, suggesting that shorter IV regimens are as efficient as longer IV regimens. A complementary analysis including only studies with median IV duration < 5 days yielded a pooled RR for complications of 0.59 (95% CI 0.09-4.07, p = 0.52). Subgroup analysis across infection types showed consistent treatment effects. Shorter IV therapy was associated with a 1-6 days reduction in hospital stay. Study methodologies and the duration of treatment and the time of transit varied across the studies. CONCLUSION:  Early switching to oral treatment in children with BJIs is as safe and effective as prolonged IV treatment and could help reduce healthcare costs and improve patient comfort. WHAT IS KNOWN: • Guidelines for osteoarticular infections treatment require prompt and prolonged antibiotic therapy. • Studies suggest that early transition to oral antibiotic therapy results in outcomes comparable to those of prolonged intravenous treatment. WHAT IS NEW: • Shorter intravenous treatment and early transition to oral antibiotics are associated with fewer complications and similar efficacy compared with prolonged intravenous therapy in pediatric osteoarticular infections. • Early switch to oral therapy (≤ 5 days of IV treatment) after clinical stability results in fewer complications than prolonged IV therapy.