Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis
By K. Iversen, N. Ihlemann, Sabine Gill, T. Madsen, H. Elming, K. Jensen, N. Bruun, D. Høfsten, Kurt Fursted, J. J. Christensen and 11 more. New England Journal of Medicine, 2019
634 citations recorded by the source corpus.
BACKGROUND Patients with infective endocarditis on the left side of the heart are typically treated with intravenous antibiotic agents for up to 6 weeks. Whether a shift from intravenous to oral antibiotics once the patient is in stable condition would result in efficacy and safety similar to those with continued intravenous treatment is unknown. METHODS In a randomized, noninferiority, multicenter trial, we assigned 400 adults in stable condition who had endocarditis on the left side of the heart caused by streptococcus, Enterococcus faecalis, Staphylococcus aureus, or coagulase‐negative staphylococci and who were being treated with intravenous antibiotics to continue intravenous treatment (199 patients) or to switch to oral antibiotic treatment (201 patients). In all patients, antibiotic treatment was administered intravenously for at least 10 days. If feasible, patients in the orally treated group were discharged to outpatient treatment. The primary outcome was a composite of all‐cause mortality, unplanned cardiac surgery, embolic events, or relapse of bacteremia with the primary pathogen, from the time of randomization until 6 months after antibiotic treatment was completed. RESULTS After randomization, antibiotic treatment was completed after a median of 19 days (interquartile range, 14 to 25) in the intravenously treated group and 17 days (interquartile range, 14 to 25) in the orally treated group (P=0.48). The primary composite outcome occurred in 24 patients (12.1%) in the intravenously treated group and in 18 (9.0%) in the orally treated group (between‐group difference, 3.1 percentage points; 95% confidence interval, ‐3.4 to 9.6; P=0.40), which met noninferiority criteria. CONCLUSIONS In patients with endocarditis on the left side of the heart who were in stable condition, changing to oral antibiotic treatment was noninferior to continued intravenous antibiotic treatment. (Funded by the Danish Heart Foundation and others; POET ClinicalTrials.gov number, NCT01375257.)
Subfields: Epidemiology, Infectious Diseases, Surgery
View Paper: https://www.semanticscholar.org/paper/0eaf785e26e63769b6c49731816ab2d6b8f19dc1
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In Infectious Diseases
Citations in the corpus
- Bacterial and fungal co-infection in individuals with coronavirus: A rapid review to support COVID-19 antimicrobial prescribing (2020, background): “[48] [49] [50] [51] With a need to ensure that bed capacity is maintained, a focus on developing guidance on optimal pharmacokineticpharmacodynamic strategies for common infections requiring antimicrobial should be considered to support early oral antibiotic switch and treatment de-escalation in pat”
- The Enterococcus: a Model of Adaptability to Its Environment (2019, background): “More recently, an impressive Danish study (278) showed that a regimen consisting of 17 days of intravenous treatment for endocarditis caused by one of four species (S.”