[Sequential Oral Therapy for Endocarditis: Current Evidence and Clinical Practice]

For decades, prolonged intravenous antibiotic therapy has been the standard of care for infective endocarditis. In light of recent evidence, this paradigm can no longer be upheld. The POET trial demonstrated that in selected patients with left-sided infective endocarditis partial oral antibiotic therapy is non-inferior to continued intravenous treatment and can be applied safely in the long term. This strategy is further supported by pharmacokinetic analyses, subgroup studies, and data from Denmark, Germany, and the United States, extending its validity beyond controlled trial settings. In clinical practice, however, implementation remains cautious, largely due to persistent uncertainties regarding patient selection, the optimal timing of oral switch, and appropriate oral regimens. This article summarizes the current evidence, discusses opportunities and limitations, and provides practical guidance on the key questions of oral therapy in infective endocarditis: who, when, and how.