Abstract
BACKGROUND: Effective antimicrobial therapy for bone and joint infections (BJIs) in the pediatric population is essential to prevent serious sequelae. As literature continues to evaluate the best therapeutic route, discussions centered upon the efficacy of oral antibiotics compared to parenteral have demonstrated promising results. This study aims to provide a statistical appraisal of literature comparing oral antibiotic therapy to parenteral treatment success and complications in treating pediatric BJIs. METHODS: After PROSPERO registration (ID: CRD42023463451), PubMed, Embase, and Web of Science databases were queried for articles comparing oral and parenteral antibiotic therapies for pediatric BJIs. Studies were included if parenteral and oral regimens were used for the entire treatment duration, or if the parenteral control group was compared against an "early switch" group, where the therapeutic route was switched from parenteral to oral antibiotics within 11 days. Data for all included studies was collected, pooled, and analyzed using DerSimonian-Laird Random-effects modeling, with statistical significance defined as p-value less than 0.05. RESULTS: Meta-analysis of six early switch studies demonstrated higher odds of success for the early switch group (OR = 2.27 [1.53-3.36], I (2) = 9.20 %, p < 0.01). Five oral-only studies demonstrated higher odds of success for the oral group (OR = 2.64 [1.10-6.34], I (2) = 66.22 %, p < 0.01). Meta-analysis demonstrated significantly higher odds of uncomplicated treatment for the early switch and oral-only groups compared to parenteral groups, though heterogeneity was significant for these analyses. CONCLUSION: The findings of this meta-analysis, limited by high heterogeneity and primarily observational data, demonstrate early switch to antibiotics had higher success rates and fewer complications compared to parenteral antibiotics. Future high-quality randomized controlled trials in specific pediatric subgroups and varied resource settings are needed. LEVEL OF EVIDENCE: Level III, systematic review of one randomized controlled trial, one case-control study and six retrospective comparative studies. MESH TERMS: Osteomyelitis; Antibiotics; Anti-Bacterial Agents; Bone Diseases, Infectious; Septic Arthritis; Pediatrics.