Partial Oral Antibiotic Therapy in Infective Endocarditis: Evidence, Patient Selection, and Practical Implementation.

Area of Science:

• Infectious Diseases
• Cardiology
• Pharmacology

Background:

• Infective endocarditis (IE) traditionally requires prolonged intravenous (IV) antibiotic treatment (4-6 weeks).
• Emerging evidence suggests early transition to oral antibiotic regimens may be safe for select patients.
• Practical guidelines for implementing oral step-down therapy in IE are limited.

Purpose of the Study:

• To review evidence on the safety and efficacy of partial oral antibiotic therapy for adult IE.
• To provide practical guidance for transitioning patients from IV to oral antibiotics.

Main Methods:

• Comprehensive narrative review of randomized trials, observational studies, meta-analyses, and clinical guidelines.
• Focused on partial oral antibiotic therapy in adult IE patients.

Main Results:

• Selected afebrile, hemodynamically stable IE patients with negative blood cultures can transition to oral therapy after ≥10 days of IV treatment.
• Oral step-down therapy shows comparable rates of death, relapse, embolic events, and unplanned surgery versus prolonged IV therapy.
• Partial oral therapy significantly reduces hospital length of stay and line-related complications.

Conclusions:

• Partial oral antibiotic therapy is a safe, evidence-based strategy for many left-sided IE patients when using strict selection criteria and structured protocols.
• Further research is needed for specific populations (e.g., IV drug users, MDR pathogens) and pharmacokinetic validation of oral regimens.
• This approach aligns with antimicrobial stewardship principles.