|Oral vs. intravenous antibiotic administration after stable endocarditis on the left side of the heart|
|Guidelines of both European and American agencies recommend intravenous administered antibiotic for infective endocarditis on the left side of the heart. The initial phase of hospitalization is crucial, as intensive care and close monitoring are needed as well as the majority of disease-related complications occur in this period. Once the disease is stable, a large fraction of patients stay in the hospital for keeping the course of intravenous antibiotic treatment. Therefore, a question has been raised: can we switch intravenous antibiotic administration to the oral route safely and effectively in these stable patients? The Partial Oral Treatment of Endocarditis (POET) trial investigators published their data in a recent issue of NEJM (here).
In this multicenter, randomized, unblended, noninferiority trial, adult patients with infective endocarditis on the left side of the heart with positive blood cultures for Streptococcus, Enteroccus faecalis, Staphylococcus aureus, or coagulase-negative staphylococci, who received intravenous antibiotic treatment and subsequently became stable in disease, were recruited into this study. A total of 199 patients were assigned to continued conventional intravenous treatment, whereas 201 patients were assigned to oral antibiotic treatment. The primary outcome was a composite of all-cause death, unscheduled cardiac surgery, embolic events, or relapse of bacteremia with the primary pathogen within 6 months after the completion of antibiotics. The primary outcome took place in 24 patients (12.1%) in the intravenously treated group, and 18 participants (9.0%) in the orally treated group (OR, 0.72; 95%CI, 0.37 to 1.36). The between-group difference was 3.1% (95% CI, -3.4 to 9.6; p=0.40), which was less than the predetermined 10% threshold, indicating noninferiority was met. The incidence of side effects was similar between the two groups.
This study provides evidence supporting to discharge patients with infective endocarditis on the left side of the heart who have been treated with intravenous antibiotics and are stable in disease, for continued oral antibiotic treatment outside of hospital with similar efficacy and safety, compared to those receiving intravenous antibiotic administration in hospital.