"Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis". The New England Journal of Medicine. 2018. ClinicalTrials.gov number, NCT01375257.
Links to original sources: Wiki Journal Post Full Journal Article
In patients in stable condition with endocarditis on the left side of the heart, is a shift from intravenous to oral antibiotic treatment noninferior to continued intravenous antibiotic treatment in terms of efficacy and safety?
In patients in stable condition with left-sided endocarditis caused by specified pathogens, shifting from intravenous to oral antibiotic treatment was noninferior to continued intravenous antibiotic treatment.
Traditionally, patients with left-sided endocarditis are treated with intravenous antibiotics for up to 6 weeks. The Partial Oral Treatment of Endocarditis (POET) trial investigated whether patients in stable condition could switch to oral antibiotics without compromising treatment efficacy or safety. The trial found that, in such patients, partial oral antibiotic treatment was noninferior to conventional intravenous treatment, suggesting that part of the treatment for these patients could potentially be managed outside of the hospital.
Current guidelines from the European Society of Cardiology and the American Heart Association typically recommend a full course of intravenously administered antibiotic agents for infective endocarditis.
- Multicenter, randomized, unblinded, noninferiority trial - N=400 adults with left-sided endocarditis - Partial oral treatment (n=201) - Continued intravenous treatment (n=199) - At least 10 days of IV antibiotic treatment were administered to all patients prior to randomization - Median follow-up: 6 months after completion of antibiotic treatment
- Adults aged 18 years or older in stable condition - Diagnosis: Left-sided endocarditis on native or prosthetic valves - Pathogens: streptococcus, Enterococcus faecalis, Staphylococcus aureus, or coagulase-negative staphylococci
- Patients in the orally treated group were administered two antibiotics from different classes with different antibacterial mechanisms and metabolization processes. - Oral antibiotics were supported by pharmacokinetic measurements to ensure adequate dosing.
- Primary composite outcome: All-cause mortality, unplanned cardiac surgery, clinically evident embolic events, or relapse of bacteremia with the primary pathogen (up to 6 months post-treatment) - The primary composite outcome occurred in 12.1% of the intravenously treated group and 9.0% of the orally treated group (P=0.40). Criticisms - Trial did not include patients with endocarditis caused by pathogens other than the specified four, those with culture-negative endocarditis, or a significant number of intravenous drug users. - The generalizability of the findings to settings with higher rates of antibiotic resistance may be limited.
Supported by unrestricted grants from the Danish Heart Foundation and others.
- Full text of this trial is available at [NEJM.org](http://www.nejm.org).