Partial Oral vs Intravenous Antibiotic Therapy for Infective Endocarditis

Overview

This retrospective cohort study compared outcomes of infective endocarditis (IE) patients treated with either intravenous (IV) antibiotics alone or partial oral antibiotic therapy, managed by a multidisciplinary team. Results showed no significant differences in 90-day relapsed infection or all-cause mortality between the two groups, supporting the safety and effectiveness of partial oral therapy in selected patients.

Background

Infective endocarditis is a serious infection with high morbidity and mortality, traditionally treated with prolonged intravenous antibiotics. Recent studies suggest partial oral antibiotic therapy may be noninferior to exclusive IV treatment, but adoption in North America remains limited. European guidelines have incorporated oral therapy recommendations, while American guidelines have not been updated since 2015. This study evaluates real-world outcomes of partial oral therapy in a US setting with a multidisciplinary team approach, including patients with substance use disorder.

Data Highlights

Key Findings

• No significant difference in 90-day relapsed infection rates between IV-only and partial oral therapy groups (2.2% vs 0.7%; P = .32).
• 90-day all-cause mortality was not significantly different (6.5% IV vs 2.8% oral; P = .17).
• Valve surgery was more frequent in the partial oral therapy group (40.9% vs 28.0%; P = .04).
• Multivariable analysis showed oral therapy was not associated with increased 90-day mortality (OR 1.72; 95% CI 0.41–7.24; P = .46).
• Independent predictors of mortality included older age, acute heart failure, and discharge before medically advised.
• No difference in outcomes for patients with MRSA transitioned to oral therapy.

Clinical Implications

Partial oral antibiotic therapy for infective endocarditis, when selected and managed by a multidisciplinary team, appears to be a safe and effective alternative to exclusive intravenous treatment. This approach may facilitate earlier discharge and reduce healthcare resource utilization without compromising patient outcomes. Clinicians should consider patient stability, pathogen susceptibility, and multidisciplinary input when selecting candidates for oral stepdown therapy.

Conclusion

In a multidisciplinary care setting, partial oral antibiotic therapy for infective endocarditis yields comparable 90-day relapse and mortality outcomes to intravenous therapy alone. These findings support incorporation of oral therapy protocols consistent with European guidelines into clinical practice for selected patients.

References

1. Iversen et al 2019 -- Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis
2. Freling et al 2022 -- Outcomes of Oral Antibiotic Therapy for Endocarditis in the US
3. European Society of Cardiology Guidelines 2020 -- Management of Infective Endocarditis
4. American Heart Association 2015 -- Infective Endocarditis Guidelines