Oral Therapy for Infective Endocarditis: Where Do We Stand?

Area of Science:

• Infectious Diseases
• Pharmacology
• Clinical Medicine

Background:

• Standard infective endocarditis (IE) treatment involves 4-6 weeks of intravenous (IV) antibiotics, leading to long hospital stays and high costs.
• Oral antibiotic therapy (OAT) is emerging as a cost-effective, patient-centered step-down strategy for stable IE patients.

Purpose of the Study:

• To review the clinical evidence, pharmacokinetic/pharmacodynamic (PK/PD) rationale, and practical aspects of using OAT in IE.
• To evaluate OAT as a transition from IV therapy for selected IE cases.

Main Methods:

• Review of clinical evidence, including the POET randomized controlled trial (RCT).
• Analysis of pharmacokinetic and pharmacodynamic properties of oral antibiotics (amoxicillin, fluoroquinolones, linezolid, rifampicin).
• Inclusion of real-world studies and meta-analyses comparing OAT with IV therapy.

Main Results:

• OAT demonstrated non-inferiority to IV therapy in stable left-sided IE patients (POET trial).
• Comparable efficacy and safety of OAT, with reduced complications and shorter hospitalizations.
• ESC guidelines now incorporate OAT for specific stable IE patients.

Conclusions:

• OAT is a safe and effective option for selected IE patients, reducing IV antibiotic duration.
• This approach facilitates shorter hospital stays and potentially lowers healthcare costs.
• Further research is needed for complex cases like MRSA, Gram-negative, or pediatric IE.