Belief in the superiority of intravenous antibiotics is widespread among health professionals and patients, but it is not supported by good evidence according to Philip Bejon, from the University of Oxford, UK, and colleagues in a new Essay published in PLOS Medicine.
While the authors note that there are situations where parenteral antibiotics (antibiotics provided via a non-oral route) are an absolute requirement, for example when a patient cannot swallow or absorb oral antibiotics, they also highlight that in many situations clinical features suggest that oral medication would be appropriate.
An important consideration is that intravenous antibiotic therapy may result in harmful complications such as local or systemic infection including bacteraemia, as well as prolonging the duration of inpatient stay in a hospital.
The authors note that, "[t]he preference for intravenous therapy may be a legacy of the discovery of antibiotics. Penicillin acquired enduring fame by providing a dramatic cure following intravenous administration to acutely unwell patients... Antibiotics that were well absorbed when administered orally became available in the years that followed but made less of an impression without similar stories of "miracle cures.""
The authors conclude, "[t]he preference for intravenous antibiotics needs challenging and only large-scale trial data can overcome strongly held personal anecdotes and third-party institutional policy assumptions in which hospitalisation equals intravenous therapy."