Plos: Antibiotics that are well absorbed after oral administration are
available, and the best current evidence suggests they are safe and
effective for many conditions.
Belief in the superiority of intravenous antibiotics is widespread
among health professionals and patients, but it is not supported by good
evidence. Expanding the evidence base will provide patients and
clinicians with further reassurance in specific situations, but reasons
for the belief in the strength of intravenous therapy also need to be
understood and addressed.
Trials expanding the evidence base might follow noninferiority
designs, based on the precedent of widespread intravenous use. For many
indications, the theoretical reasons for preferring intravenous therapy
are not strong, and the risks of intravenous therapy are well
established. It would be more logical for many indications to regard
oral antibiotics as the default position and require trial designs to
test the superiority of intravenous therapy.
Clarity regarding the harms and benefits of intravenous antibiotics
is needed. There is potential to change global clinical practice for the
better, reducing health care costs and minimizing harm to patients.