Switching to Oral Antibiotic Noninferior to Intravenous Antibiotic for Infective Endocarditis

Switching from intravenous antibiotics to oral antibiotics for the treatment of endocarditis was noninferior to continuing intravenous treatment, new study results presented at the American College of Cardiology Annual Scientific Sessions in New Orleans suggested.

Researchers for the POET trial enrolled a total of 400 patients with left-sided endocarditis who were in stable condition and responded satisfactorily to intravenous at least 10 days of antibiotic treatment prior to randomization. Patients were randomly assigned to either continue with usual treatment with the intravenous antibiotic, or switch to the oral treatment for an average duration of 17 days. The primary study endpoint was a composite of any-cause death, unplanned cardiac surgery, embolic events, and relapse infection.

The results indicated that 53 patients experienced the primary study endpoint in the oral treatment group compared to 76 patients in the intravenous group (26.4% vs. 38.2%, respectively; HR=0.64; 95% CI, 0.45 to 0.91; P=0.01). For the components of the primary endpoint, only any-cause death saw a significant improvement with oral treatment versus intravenous treatment (27.1% vs. 16.4%, respectively; P=0.009). The other improvement came with the reduced hospital stay, which was much higher in the intravenous group (who stayed for the duration of the treatment) than for those switching to an oral treatment (19 median days vs. 3 median days; P<0.001)

“The efficacy and safety of changing to oral antibiotic treatment was non-inferior to continued intravenous antibiotic treatment short-term, [and we now have] reassuring longer-term outcomes,” Dr. Henning Bundgaard, MD, PhD, DMSc, a professor of cardiology at the Heart Center at the National University Hospital in Copenhagen, Denmark, in his presentation. “More than 50% of patients with endocarditis may be candidates to partial oral antibiotic treatment.”

Change in Standard Care

Dr. Bundgaard also said in a press release that the results may call for a change in standard care delivery.

“In stabilized patients with left-sided infectious endocarditis, a switch from intravenous to oral antibiotic therapy showed superior efficacy and safety compared with continued intravenous treatment,” he said. “These findings clearly support a change in the standard of care for this condition.”

The POET trial was, according to the press release, the largest randomized trial of patients with infectious endocarditis. Current guidelines from several organizations call for six weeks of intravenous antibiotics in patients with left-sided infective endocarditis. Some research has suggested that extended hospital stay while treatment is administered increases the risk for complications. There is also research indicating that shorter hospital stays are associated with overall better outcomes.

The study results were published in the New England Journal of Medicine.

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