Switching IV to Oral Antibiotics Noninferior for Some Endocarditis Events

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Orally administered antibiotics following intravenously administered antibiotics to treat endocarditis caused by streptococcus, E faecalis, S aureus, or coagulase-negative staphylococci was found to b
Orally administered antibiotics following intravenously administered antibiotics to treat endocarditis caused by streptococcus, E faecalis, S aureus, or coagulase-negative staphylococci was found to b

Shifting to oral antibiotics from intravenous (IV) antibiotics is noninferior to continued IV administration in patients with infective endocarditis of the left side of the heart caused by streptococcus, Enterococcus faecalis, Staphylococcus aureus, or coagulase-negative staphylococci, according to a study published in The New England Journal of Medicine.

A group of researchers in Denmark conducted a randomized, unblinded, noninferiority, multicenter study (POET; ClinicalTrials.gov Identifier: NCT01375257) to assess the efficacy of shifting from IV to oral antibiotics vs continued IV antibiotic treatment.

The primary outcome was a combination of all-cause mortality, unplanned cardiac surgery, clinically relevant embolic events, or relapse of bacteremia after randomization through 6 months after treatment completion.

Patients with stable endocarditis (aged ≥18 years) on the left side of the heart and  blood culture results for streptococcus, E faecalis, S aureus, or coagulase-negative staphylococci, who were being treated with IV antibiotics, were eligible to participate in the study. A total of 400 participants were randomly assigned (1:1 ratio) to receive either continued IV antibiotics (n = 199) or switched to oral antibiotics (n = 201). All participants received IV treatments for a minimum of 10 days.

The median antibiotic treatment completion was 19 days for the continued IV treatment cohort and 17 days for the oral treatment cohort. The combined primary outcome was reported in 42 (10.5%) participants: 24 (12.1%) from the IV cohort and 18 (9.0%) from the oral cohort (odds ratio, 0.72; between-group difference, 3.1 percentage points).

Treatment-linked adverse events were reported in 22 patients: 12 (6%) from the IV cohort and 10 (5%) from the oral cohort. Allergy (50%), bone marrow suppression (27%), and gastrointestinal effects (14%), were the most common adversities reported; there were no statistical differences between the 2 groups.

“In conclusion, in patients who had endocarditis on the left side of the heart caused by streptococcus, E faecalis, S aureus, or coagulase-negative staphylococci and who were in stable condition, a shift from intravenously administered to orally administered antibiotic treatment was noninferior to continued intravenous antibiotic treatment,” the authors wrote.

Reference

Iversen K, Ihlemann N, Gill SU, et al. Partial oral versus intravenous antibiotic treatment of endocarditis [published online August 28, 2018]. N Engl J Med. doi:10.1056/NEJMoa1808312
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