Switch to Oral Antibiotics for Infective Endocarditis in Children

Although adult clinical trials support the use of partial enteral antibiotic therapy for infective endocarditis (IE), evidence supporting oral therapy for pediatric IE is lacking. Our antimicrobial stewardship program, in partnership with local stakeholders, developed a protocol in 2023 to manage pediatric IE with enteral antibiotics following initial intravenous therapy. Here we describe the clinical course and outcomes of patients treated with partial enteral antibiotic therapy for IE after protocol implementation.

We performed a retrospective review of the first 7  months of patients treated using the IE partial oral therapy protocol. A historical comparator group was included for reference. We identified patients with IE using electronic health record International Classification of Diseases, Tenth Revision diagnoses and excluded patients with fungal endocarditis or endovascular infection without vegetations. We collected patient microbiological and laboratory data, surgical procedures, echocardiogram findings, antibiotic use, length of stay, and readmissions.

We identified 12 total patients with IE during the study period; 4 patients were excluded. Eight included patients were treated with partial enteral antibiotic therapy: 4 transitioned to enteral antibiotics within the first 7  days of IE treatment, and 3 transitioned after approximately 21  days. No patient exhibited treatment failure or IE recurrence during a 90-day follow-up period. Three patients experienced adverse drug reactions that required therapy modification. There was 1 unrelated mortality.

All patients in this retrospective review were successfully transitioned to enteral antibiotic therapy. Partial oral treatment of pediatric IE is an emerging treatment strategy that requires future investigation.