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Breaking the Dogma of Intravenous Treatment for Infective Endocarditis: A Systematic Review and Meta-Analysis
Beatrice Barda1, Christian Schindler2, Enos Bernasconi1,3
1Division of Infectious Diseases, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland.
Journal of Clinical Medicine
|January 8, 2025
Summary
Switching infective endocarditis (IE) patients to oral antibiotics is a viable option. This meta-analysis shows oral switch therapy reduces relapse rates without impacting treatment failure or mortality.
Area of Science:
- Infectious Diseases
- Pharmacology
- Clinical Medicine
Background:
- Infective endocarditis (IE) treatment traditionally involves prolonged intravenous antibiotics.
- Previous attempts to establish oral switch therapy have had limited success.
- Recent reports suggest efficacy in selected IE patients, necessitating further evaluation.
Purpose of the Study:
- To evaluate the benefits of early oral switch therapy in IE.
- To compare oral switch therapy with intravenous treatment regarding microbiological cure, relapse, mortality, and length of hospital stay (LOS).
Main Methods:
- A meta-analysis was conducted using data from six studies identified via a Medline search.
- Analysis included 840 patients on intravenous treatment and 677 on oral treatment.
- A sensitivity analysis was performed excluding three non-randomized trials.
Main Results:
- Oral switch therapy was associated with a reduced relapse rate (OR: 0.54, 95% CI: 0.31-0.92).
- No statistically significant differences were found in treatment failure, length of hospitalization, complication rates, or mortality.
- The findings support oral switch therapy as a feasible option for selected IE patients.
Conclusions:
- Oral switch therapy is a feasible and potentially beneficial treatment option for clinically stable patients with infective endocarditis.
- This approach appears superior to intravenous treatment in reducing infection relapse.
- The findings support the wider implementation of oral switch therapy in IE management.
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