Real-world Application of Oral Therapy for Infective Endocarditis

Dr. Chadwick Clinical question: Does oral transitional antibiotic therapy have similar outcomes to intravenous (IV)-only antibiotic treatment for infective endocarditis (IE)? Background: There has been a longstanding belief, not supported by strong evidence, that deep infections such as IE require prolonged IV antibiotics, although it is known that long-term IV therapy is associated with adverse events. Despite previous evidence suggesting oral transitional therapy for IE to be at least as effective as IV-only treatment, this practice has yet to be adopted into the standard of care, possibly due to an absence of real-world outcomes outside of carefully controlled randomized clinical trials. Study design: Multi-center, retrospective, cohort study Setting: Three acute care public hospitals in the Los Angeles County Department of Health Services, between December 2018 and June 2022 Synopsis: Chart review identified 257 adults with definite or possible IE who were treated with IV-only (n=211) versus IV then oral transitional therapy (n=46). Oral transitional therapy was initiated when patients met specific criteria. The primary efficacy endpoint was clinical success, defined as being alive, without recurrent bacteremia, and without treatment-emergent infectious complications within 90 days. Clinical success rates were similar in both the IV-only arm (84.4%) and the oral-therapy arm (87%) at 90 days. A similar rate of patients in the IV-only versus oral cohorts failed to complet...
Source: The Hospitalist - Category: Hospital Management Authors: Tags: Cardiology Drug Therapy In the Literature Source Type: research