Oral or IV (intravenous) antibiotics? Which is the way forward?

Written by: Dr Prash Vas
Published: | Updated: 12/04/2023
Edited by: Emma McLeod

When it comes to antibiotics for orthopaedic infections, you might have been offered intravenous antibiotics, but could oral antibiotics provide the same level of treatment or be even more effective? Dr Prash Vas, a leading London endocrinologist, explains how the OVIVA trial investigated this and the findings discovered.

An intravenous injection in a patient's hand

Which type of antibiotic is traditionally used?

For many decades, bone and joint (orthopaedic) infections have mainly been treated via intravenous (IV) antibiotics for six weeks or longer.


The OVIVA trial

In 2013, a study concluded that as long as bacteria was being targeted by an antibiotic, the method of giving antibiotics had no considerable impact on the rate of recovery. The main objective of the OVIVA trial (Oral versus Intravenous Antibiotics for Bone and Joint Infection) was to investigate this 2013 finding.


The trial involved 1054 UK patients and observed the outcome of their treatment after one year. It compared patients who switched quickly from IV to oral antibiotics and patients who only received IV antibiotics. Of these patients, 83 per cent had lower limb infections and 17 per cent had foot infections.


Which was more successful? IV or oral antibiotics?

Despite the different administration methods and sites of infection, no notable difference in treatment success was found. Interestingly, a longer hospital stay and a higher rate of complications were noted for those who received only IV antibiotics compared to patients in the oral group, and thus oral antibiotics could be as effective for the patient.


While more studies are needed to confirm if oral antibiotics prove the same or better than IV antibiotics, the OVIVA trial represents an evolution in the treatment for bone and joint infections.


To discover how you can benefit from Dr Vas’ first-class patient care, visit his profile and arrange your first consultation.

By Dr Prash Vas
Endocrinology, diabetes & metabolism

 Dr Prash Vas holds a dual certification in diabetes/endocrinology and general internal medicine and has extensive experience as a consultant at the highest level since 2013. In the NHS, he is currently the King’s Health Partners consultant in diabetes and endocrinology with a specialist focus in diabetes foot medicine being based both at King’s College Hospital and Guy’s and St Thomas’ Hospitals. Prior to that completed his training in diabetes and endocrinology at Addenbrookes Hospital, Cambridge. He is an honorary senior clinical lecturer at King’s College, London and a visiting professor at Staffordshire University. Additionally, he chairs the South East Thames Diabetes Physicians Group (SETDPG) and is the current research lead for diabetes at King’s College Hospital.

Dr Vas has extensive clinical experience in all aspects of diabetes care with a special interest in the complex management of Type 2 and Type 1 diabetes. In endocrinology, he has an interest in thyroid disorders and works alongside key experts for complex endocrine presentations which often require multi-professional consensus.  Dr Vas is internationally recognised in the management of diabetic foot disease including neuropathic pain and has extensively championed the cause of early recognition of the ‘diabetic foot attack’. From a general medical perspective, he has wide experience in the management of a wide range of acute and chronic medical disorders and in providing care coordination required for a successful peri-operative pathway. Dr Vas has a focus on patient-centred care and is passionate about a collaborative approach towards achieving optimal outcomes in healthcare.

A well-established academic, Dr Vas’s current research is focused on the lower limb complications of diabetes including the aetiopathogenesis and treatment of diabetic foot ulcers, diabetic neuropathy (especially small-fibre neuropathy) neuropathic pain and the validation of new techniques designed for the early detection of neuropathy. He also has an interest in endocrine conditions which can lead to small fibre neuropathy, in particular thyroid disorders. He ranks highly for his research output in diabetic foot (Expertscape 2022 World Top 20) and diabetic neuropathy (Expertscape 2022 World Top 50). He is frequently invited to speak internationally on these subjects. He is a board member of the Diabetic Foot Study Group (DFSG) and serves as an expert to the International Working Group on Diabetic Foot (IWGDF)and has provided expert input to the National Institute for Health and Care Excellence (NICE). He is the co-founder of the Diabetes Neuropathy Network, a global consortium of clinicians devoted to raising awareness about the perils of diabetic neuropathy.

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