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OVIVA Oral Switch Osteomyelitis — SCE Infectious Diseases MCQ

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EasyAntimicrobial StewardshipOVIVA Oral Switch OsteomyelitisSCE Infectious Diseases

A 60-year-old man is being treated for vertebral osteomyelitis with IV antibiotics via a PICC line through the OPAT service. At 4 weeks, CRP has fallen from 180 to 25 mg/L and he is clinically improving. His clinician asks when IV-to-oral switch can be considered. What evidence supports oral switch?

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Correct answer: B — The OVIVA trial demonstrated non-inferiority of oral switch (after ≥1 week IV) for bone and joint infections including vertebral osteomyelitis — oral switch is appropriate when clinically improving with resolving CRP

The landmark OVIVA trial (2019, NEJM) demonstrated that early oral switch (after at least 1 week IV induction) was non-inferior to continued IV therapy for complex bone and joint infections including osteomyelitis and PJI. Key criteria for oral switch: clinically improving, CRP downtrending, organism identified with susceptible oral options (ideally highly bioavailable agents: Fluoroquinolones, Rifampicin, Linezolid, Co-trimoxazole, Doxycycline), and able to take oral medication. This has transformed OPAT practice and reduced PICC line complications.

Reference: OVIVA Trial 2019 – NEJM; BSAC 2019 – OPAT; NICE NG157 2024