Oral versus intravenous antibiotics: Oral antibiotics are more cost-effective and may be safer than intravenous antibiotics for most infections in stable adults.

Many clinicians perceive intravenous (IV) antibiotics as inherently more effective than their oral counterparts. However, randomised controlled trials (RCTs) have demonstrated that oral antibiotics are clinically equivalent to IV antibiotics for many severe bacterial infections. This includes pneumonia, skin and soft tissue infections, pyelonephritis, intra-abdominal infections, osteoarticular infections, bacteraemia and infective endocarditis. When clinically appropriate, oral treatment is more patient-friendly, cost-effective and environmentally friendly. But we still use the IV route much more than necessary. To address a historical practice that is often unwarranted, this Therapeutics Letter reviews evidence from RCTs and compares the advantages and disadvantages of oral and IV antibiotics. We suggest criteria to determine when oral therapy is appropriate.