Iversen K, et al. - Intravenous antibiotic agents are provided for up to 6 weeks to patients with infective endocarditis on the left side of the heart, so researchers investigated if shifting from intravenous to oral antibiotics, once the patient is stable, would result in comparable effectiveness and safety as those with continued intravenous treatment. Outcomes of this study suggest that a shift from initial intravenous to oral antibiotic treatment was noninferior to continued intravenous antibiotic treatment for these patients.

Methods

• Researchers undertook a randomized, noninferiority, multicenter trial including 400 adults in stable condition who had endocarditis on the left side of the heart caused by streptococcus, Enterococcus faecalis, Staphylococcus aureus, or coagulase-negative staphylococci and who were being treated with intravenous antibiotics.
• They assigned these patients to either continue intravenous treatment (199 patients) or to switch to oral antibiotic treatment (201 patients).
• All patients received antibiotic treatment intravenously for at least 10 days.
• If feasible, they discharged patients in the orally treated group to outpatient treatment.
• For this study, the primary outcome included a composite of all-cause mortality, unplanned cardiac surgery, embolic events, or relapse of bacteremia with the primary pathogen, from the time of randomization until 6 months after antibiotic treatment was completed.

Results

• After randomization, completion of antibiotic treatment was reported in the intravenously treated group and the orally treated group after a median period of 19 days (interquartile range, 14 to 25) and 17 days (interquartile range, 14 to 25), respectively.
• In the intravenously treated group and the orally treated group, occurrence of the primary composite outcome was noted in 24 patients (12.1%) and in 18 (9.0%) patients, respectively (between-group difference, 3.1 percentage points; 95% confidence interval, −3.4 to 9.6; P=0.40), which met noninferiority criteria.