[Possibilities and limits of outpatient antibiotic therapy of infective endocarditis]

Infective endocarditis has a high morbidity and lethality. Therefore antibiotic treatment has to be intravenous to achieve high blood levels and has to last several weeks without an interruption of treatment at the weekends.

It is therefore crucial to select the patient group that is suited for an outpatient, antibiotic therapy very carefully. In general only hemodynamically stable patients without complications in whom the responsible organism has been identified should be considered.

From a pharmacological point of view intravenous or intramuscular application for the complete duration of therapy is obligatory. Endocarditis caused by penicillin-susceptible streptococci, the biggest group of organisms responsible for endocarditis, can be treated with Ceftriaxon once daily for 4 weeks. For other organisms there are at present no data available which support the feasibility of an outpatient therapy. In particular antibiotic therapy with a complex regimen for those organisms is not practicable for outpatient usage. Possibly, in the near future computer controlled pumps might overcome this disadvantage.

Every outpatient therapy should be initiated under inpatient conditions and only after an initial response to the antibiotic therapy continued in an outpatient setting. Today reliable outpatient therapy and follow-up 7 days a week under the given outpatient infrastructure is problematic and remains an exception. However, considering cost-effectiveness outpatient as compared to inpatient antibiotic therapy could be an interesting economically advantageous alternative.