Do you routinely use oral antibiotics for treatment of vertebral osteomyelitis?

Speaking specifically to my clinical practice, it is very dependent on the individual patient--more or less if they can do the IV/OPAT situation, and what happened with surgery, and what organism; also, are they coming to you outpatient vs inpatient? IDSA guidelines (from 2015) still endorse IV. It is one of the few circumstances where I do still lean towards IV, but I have definitely done step down from inpatient to PO outpatient. I do like this descriptive study: Marconi et al., PMID 35959206. One of the key things with this is also ensuring appropriate dosing and tolerability. So, a lot of factors to consider, so it comes down to individual patients quite frequently--but oral is definitely a tool in the toolbox.

Generally, if there is an option based on susceptibility for use of PO agents in vertebral osteomyelitis, I think it is reasonable to use orals, but not all oral antibiotics are created equally, and there is not always an appropriate oral choice. I would choose carefully based on oral bioavailability, likelihood of target attainment, etc. I also consider the patient's ability to adhere to higher doses or frequencies of oral agents than usual dosing, which should often be used in such scenarios, especially with beta-lactams. Also consider whether patients are able to adhere to frequent monitoring; some oral agents may actually require more intense monitoring than IV therapy, such as linezolid. A number of institutions, including my own, have...