Medical Dialogues
  • Dermatology
Login Register
This site is intended for healthcare professionals only
Login Register
  • MD Brand Connect
  • Vaccine Hub
  • MDTV
    • Breaking News
    • Medical News Today
    • Health News Today
    • Latest
    • Journal Club
    • Medico Legal Update
    • Latest Webinars
    • MD Shorts
    • Health Dialogues
  • Fact Check
  • Health Dialogues
Medical Dialogues
  • Medical News & Guidelines
      • Anesthesiology
      • Cardiology and CTVS
      • Critical Care
      • Dentistry
      • Dermatology
      • Diabetes and Endocrinology
      • ENT
      • Gastroenterology
      • Medicine
      • Nephrology
      • Neurology
      • Obstretics-Gynaecology
      • Oncology
      • Ophthalmology
      • Orthopaedics
      • Pediatrics-Neonatology
      • Psychiatry
      • Pulmonology
      • Radiology
      • Surgery
      • Urology
      • Laboratory Medicine
      • Diet
      • Nursing
      • Paramedical
      • Physiotherapy
  • Health news
      • Doctor News
      • Government Policies
      • Hospital & Diagnostics
      • International Health News
      • Medical Organization News
      • Medico Legal News
      • NBE News
      • NMC News
  • Fact Check
      • Bone Health Fact Check
      • Brain Health Fact Check
      • Cancer Related Fact Check
      • Child Care Fact Check
      • Dental and oral health fact check
      • Diabetes and metabolic health fact check
      • Diet and Nutrition Fact Check
      • Eye and ENT Care Fact Check
      • Fitness fact check
      • Gut health fact check
      • Heart health fact check
      • Kidney health fact check
      • Medical education fact check
      • Men's health fact check
      • Respiratory fact check
      • Skin and hair care fact check
      • Vaccine and Immunization fact check
      • Women's health fact check
  • AYUSH
    • Ayurveda
    • Homeopathy
    • Siddha
    • Unani
    • Yoga
  • State News
      • Andaman and Nicobar Islands
      • Andhra Pradesh
      • Arunachal Pradesh
      • Assam
      • Bihar
      • Chandigarh
      • Chattisgarh
      • Dadra and Nagar Haveli
      • Daman and Diu
      • Delhi
      • Goa
      • Gujarat
      • Haryana
      • Himachal Pradesh
      • Jammu & Kashmir
      • Jharkhand
      • Karnataka
      • Kerala
      • Ladakh
      • Lakshadweep
      • Madhya Pradesh
      • Maharashtra
      • Manipur
      • Meghalaya
      • Mizoram
      • Nagaland
      • Odisha
      • Puducherry
      • Punjab
      • Rajasthan
      • Sikkim
      • Tamil Nadu
      • Telangana
      • Tripura
      • Uttar Pradesh
      • Uttrakhand
      • West Bengal
  • Medical Education
      • Ayush Education News
      • Dentistry Education News
      • Medical Admission News
      • Medical Colleges News
      • Medical Courses News
      • Medical Universities News
      • Nursing education News
      • Paramedical Education News
      • Study Abroad
  • Industry
      • Health Investment News
      • Health Startup News
      • Medical Devices News
      • Pharma News
      • Pharmacy Education News
      • Industry Perspective
  • MDTV
      • Health Dialogues MDTV
      • Health News today MDTV
      • Latest Videos MDTV
      • Latest Webinars MDTV
      • MD shorts MDTV
      • Medical News Today MDTV
      • Medico Legal Update MDTV
      • Top Videos MDTV
      • Health Perspectives MDTV
      • Journal Club MDTV
      • Medical Dialogues Show
This site is intended for healthcare professionals only
LoginRegister
Medical Dialogues
LoginRegister
  • Home
  • Medical news & Guidelines
    • Anesthesiology
    • Cardiology and CTVS
    • Critical Care
    • Dentistry
    • Dermatology
    • Diabetes and Endocrinology
    • ENT
    • Gastroenterology
    • Medicine
    • Nephrology
    • Neurology
    • Obstretics-Gynaecology
    • Oncology
    • Ophthalmology
    • Orthopaedics
    • Pediatrics-Neonatology
    • Psychiatry
    • Pulmonology
    • Radiology
    • Surgery
    • Urology
    • Laboratory Medicine
    • Diet
    • Nursing
    • Paramedical
    • Physiotherapy
  • Health news
    • Doctor News
    • Government Policies
    • Hospital & Diagnostics
    • International Health News
    • Medical Organization News
    • Medico Legal News
    • NBE News
    • NMC News
  • Fact Check
    • Bone Health Fact Check
    • Brain Health Fact Check
    • Cancer Related Fact Check
    • Child Care Fact Check
    • Dental and oral health fact check
    • Diabetes and metabolic health fact check
    • Diet and Nutrition Fact Check
    • Eye and ENT Care Fact Check
    • Fitness fact check
    • Gut health fact check
    • Heart health fact check
    • Kidney health fact check
    • Medical education fact check
    • Men's health fact check
    • Respiratory fact check
    • Skin and hair care fact check
    • Vaccine and Immunization fact check
    • Women's health fact check
  • AYUSH
    • Ayurveda
      • Ayurveda Giuidelines
      • Ayurveda News
    • Homeopathy
      • Homeopathy Guidelines
      • Homeopathy News
    • Siddha
      • Siddha Guidelines
      • Siddha News
    • Unani
      • Unani Guidelines
      • Unani News
    • Yoga
      • Yoga Guidelines
      • Yoga News
  • State News
    • Andaman and Nicobar Islands
    • Andhra Pradesh
    • Arunachal Pradesh
    • Assam
    • Bihar
    • Chandigarh
    • Chattisgarh
    • Dadra and Nagar Haveli
    • Daman and Diu
    • Delhi
    • Goa
    • Gujarat
    • Haryana
    • Himachal Pradesh
    • Jammu & Kashmir
    • Jharkhand
    • Karnataka
    • Kerala
    • Ladakh
    • Lakshadweep
    • Madhya Pradesh
    • Maharashtra
    • Manipur
    • Meghalaya
    • Mizoram
    • Nagaland
    • Odisha
    • Puducherry
    • Punjab
    • Rajasthan
    • Sikkim
    • Tamil Nadu
    • Telangana
    • Tripura
    • Uttar Pradesh
    • Uttrakhand
    • West Bengal
  • Medical Education
    • Ayush Education News
    • Dentistry Education News
    • Medical Admission News
    • Medical Colleges News
    • Medical Courses News
    • Medical Universities News
    • Nursing education News
    • Paramedical Education News
    • Study Abroad
  • Industry
    • Health Investment News
    • Health Startup News
    • Medical Devices News
    • Pharma News
      • CDSCO (Central Drugs Standard Control Organisation) News
    • Pharmacy Education News
    • Industry Perspective
  • Home
  • Surgery
  • Surgery News
  • Oral Antibiotics...

Oral Antibiotics Noninferior to IV Treatment for Fracture-Related Infections: JAMA

Written By : Medha Baranwal |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2025-01-29T21:00:45+05:30  |  Updated On 29 Jan 2025 9:00 PM IST
Oral Antibiotics Noninferior to IV Treatment for Fracture-Related Infections: JAMA
  • facebook
  • twitter
  • linkedin
  • whatsapp
  • Telegram
  • Email

USA: The management of fracture-related infections (FRIs) often involves prolonged antibiotic therapy, with intravenous (IV) administration traditionally being the standard. However, recent findings from the POvIV Randomized Clinical Trial offer compelling evidence that oral antibiotics may be a viable alternative to IV therapy in certain cases, potentially simplifying treatment protocols and improving patient convenience.

The authors revealed that oral antibiotic treatment was noninferior to intravenous treatment concerning the primary outcome, the number of surgical interventions, as determined by the mITT analysis. However, the researchers noted some uncertainty in these findings based on the results of preplanned and post hoc secondary analyses. A similar trend in treatment effect estimates was observed for the secondary outcome, which evaluated the recurrence of infection. The findings were published online in JAMA Surgery.

Fracture-related infection is a significant complication following fracture fixation surgery, often requiring debridement and a six-week course of IV antibiotics as the standard treatment. While IV antibiotics have been the traditional approach, laboratory data, and retrospective clinical studies suggest that oral antibiotics could be an effective alternative, offering advantages such as lower costs and potentially fewer complications.

Against this backdrop, William T. Obremskey, MD, MPH, MMHC, Vanderbilt University Medical Center, Nashville, TN, and colleagues from the Major Extremity Trauma Research Consortium (METRC), aimed to evaluate the effectiveness of oral antibiotics compared to IV antibiotics in the treatment of FRIs, providing evidence to inform future clinical decision-making.

For this purpose, the researchers conducted the POvIV multicenter, prospective randomized clinical trial across 24 trauma centers in the US, enrolling patients aged 18 to 84 years with fracture repair or arthrodesis involving implants who developed fracture-related infections (FRIs) without radiographic evidence of osteomyelitis. Patients were followed for 12 months after hospitalization between March 2013 and September 2018.

The trial compared oral and intravenous (IV) antibiotics. The primary outcome was the number of study injury-related surgical interventions within a year. Secondary outcomes included the recurrence of deep surgical site infections, which were analyzed using preplanned and post hoc methods to ensure reliability.

The following were the key findings of the study:

  • The study included 233 patients with a mean age of 46.0 years, and 22.7% of patients were female.
  • The mean number of surgical interventions within one year was 1.3 for the oral group and 1.1 for the IV group.
  • The upper bound of the 95% confidence interval for the mean difference in the unadjusted mITT analysis was 0.59, which was below the prespecified noninferiority margin of 0.67, suggesting noninferiority of oral to IV antibiotics.
  • The adjusted PP analysis did not support the noninferiority of the number of reoperations.
  • A post hoc adjusted mITT analysis indicated noninferiority.
  • The treatment effect estimates for reinfection, a key secondary outcome, followed a similar pattern to the primary outcome.

The POvIV randomized clinical trial demonstrates that oral antibiotics are noninferior to IV antibiotics for the primary outcome of surgical interventions based on mITT analyses. However, oral antibiotics did not show noninferiority in the secondary PP analysis. While reinfection rates were similar in the unadjusted mITT analysis, adjusted mITT and PP analyses revealed greater differences.

"These findings can assist clinicians and patients in making informed decisions about antibiotic care for FRIs," the researchers concluded.

Reference:

Major Extremity Trauma Research Consortium (METRC). Oral vs Intravenous Antibiotics for Fracture-Related Infections: The POvIV Randomized Clinical Trial. JAMA Surg. Published online January 22, 2025. doi:10.1001/jamasurg.2024.6439


JAMA Surgeryfracture-related infectionsIntravenous Antibioticsoral antibioticsPOvIV trial
Source : JAMA Surgery
Medha Baranwal
Medha Baranwal

    MSc. Biotechnology

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

    Show Full Article
    Next Story

    Editorial

    U.S. FDA Drug Safety Alert: Warning Issued for Severe Itching After Stopping Long-Term Cetirizine or Levocetirizine Use

    U.S. FDA Drug Safety Alert: Warning Issued for Severe Itching After Stopping Long-Term Cetirizine or...

    Aspirin in Primary Prevention: Prudent Guideline-Based Approach

    Aspirin in Primary Prevention: Prudent Guideline-Based Approach

    Prediabetes and CKD: An Overlooked Interaction in Early Metabolic Disease

    Prediabetes and CKD: An Overlooked Interaction in Early Metabolic Disease

    Environmental Impact on Seborrheic Dermatitis, Tinea versicolor and Dandruff: The Role of Selenium Sulfide in Seborrheic Dermatitis Management

    Environmental Impact on Seborrheic Dermatitis, Tinea versicolor and Dandruff: The Role of Selenium...

    Real-World Case study: Darbepoetin Alfa for Chemotherapy-Induced Anemia in stage IV metastatic gallbladder cancer - Dr AVS Suresh

    Real-World Case study: Darbepoetin Alfa for Chemotherapy-Induced Anemia in stage IV metastatic...

    View All

    Journal Club Today

    Sleeping 2 Extra Hours on Weekends May Calm Teen Anxiety: Study Suggests

    Sleeping 2 Extra Hours on Weekends May Calm Teen Anxiety: Study Suggests

    View All

    Health News Today

    Health Bulletin 16/June/2025

    Health Bulletin 16/June/2025

    View All
    © 2022 All Rights Reserved.
    Powered By: Hocalwire
    X
    We use cookies for analytics, advertising and to improve our site. You agree to our use of cookies by continuing to use our site. To know more, see our Cookie Policy and Cookie Settings.Ok