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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Antimicrobials for right-sided endocarditis in intravenous drug users: a systematic review

Derek Yung1, Dan Kottachchi, Binod Neupane

  • 1Department of Medicine, McMaster University, Hamilton, Ontario, Canada.

The Journal of Antimicrobial Chemotherapy
|September 21, 2007
PubMed
Abstract

Insights

This systematic review found no evidence that one antimicrobial regimen is superior to another for treating right-sided endocarditis (RSE) in intravenous drug users (IVDUs). Further research is needed to determine optimal treatment strategies for RSE in this population.

Area of Science:

  • Infectious Diseases
  • Cardiology
  • Pharmacology

Background:

  • Right-sided endocarditis (RSE) is a significant complication associated with intravenous drug use (IVDU).
  • Evidence regarding antimicrobial efficacy for clinical cure in IVDUs with isolated native valve RSE requires systematic evaluation.

Purpose of the Study:

  • To systematically review randomized controlled trials (RCTs) evaluating antimicrobial regimens for clinical cure in IVDUs with isolated native valve RSE.

Main Methods:

  • Searched MEDLINE, EMBASE, and Cochrane CENTRAL Register (1966-2006).
  • Included RCTs comparing single or combination antibiotic regimens for isolated native valve bacterial RSE.
  • Assessed clinical and microbiological cure and failure outcomes between 2 weeks and 6 months post-therapy.
  • Evaluated study quality using an objective scoring scale.

Main Results:

  • Identified seven RCTs: one single vs. single, four combination vs. single, and two combination vs. combination.
  • Short-course therapy was evaluated in three studies, with only one directly comparing short- and long-course therapy.
  • No statistically significant benefit was found for any antimicrobial therapy.
  • All included studies exhibited a moderate to severe risk of bias.

Conclusions:

  • Current randomized trial evidence does not support the superiority of any specific antimicrobial regimen for treating RSE in IVDUs.
  • The lack of clear evidence highlights the need for further high-quality research to guide treatment decisions.

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