Partial Oral Therapy for Infective Endocarditis Among Adult Infectious Diseases Physicians in the United States: An Emerging Infections Network Survey - Report - MDSpire
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Partial Oral Therapy for Infective Endocarditis Among Adult Infectious Diseases Physicians in the United States: An Emerging Infections Network Survey
Survey of U.S. ID Physicians on Partial Oral Therapy Use for Infective Endocarditis
Overview
A survey of 452 U.S. adult infectious diseases physicians revealed that partial oral therapy (POT) for infective endocarditis (IE) remains infrequently used, with only 10% employing it in more than 25% of cases. Comfort with POT varied by pathogen, and major barriers included fear of relapse and adherence concerns.
Background
Infective endocarditis carries high mortality despite advances in treatment, traditionally managed with prolonged intravenous antibiotics via outpatient parenteral antimicrobial therapy (OPAT). Recent trials, such as POET, support partial oral therapy as a noninferior alternative in select patients, but uptake in the U.S. is unclear. European guidelines now recommend POT under strict criteria, while U.S. guidelines remain cautious, especially for certain pathogens and patient populations.
Data Highlights
Parameter
Value
Survey response rate
34% (516/1531)
Respondents managing IE
452 (88%)
Frequency of POT use
16% never; 53% ≤10% cases; 10% >25% cases
Frequent POT use by caseload
23% (>50 IE cases/year) vs ≤9% (lower volume), P < .001
Availability of active oral agent (75%), pathogen (69%)
Principal barriers
Fear of relapse (72%), adherence concerns (53%), insufficient evidence (48%)
Desire for clearer guidelines
75%
Desire for additional data
71%
Key Findings
Partial oral therapy for IE is infrequently used by U.S. adult ID physicians, with only 10% using it in more than a quarter of cases.
Physicians with higher IE caseloads and fewer years in practice are more likely to use POT frequently.
Comfort with switching to oral therapy varies by pathogen, highest for Streptococcus spp. and lowest for MRSA.
Fear of relapse, concerns about patient adherence, and perceived insufficient evidence are major barriers to POT adoption.
Availability of an active oral agent and the causative pathogen are key factors influencing POT decisions.
Most physicians desire clearer guidelines and more clinical trial data to support POT use.
Clinical Implications
Despite emerging evidence supporting partial oral therapy for infective endocarditis, its adoption remains limited in the U.S. Clinicians should consider pathogen-specific factors and patient adherence when evaluating POT candidacy. Enhanced guideline clarity and expanded outpatient antimicrobial services may facilitate broader, safer implementation of POT.
Conclusion
U.S. adult infectious diseases physicians currently adopt partial oral therapy for infective endocarditis sparingly, influenced by clinical experience, pathogen, and concerns about relapse and adherence. Updated guidelines and further evidence are needed to support wider use.
References
Brennan et al. 2025 -- Survey of Adult Infectious Diseases Physicians in the U.S. on the Use of Partial Oral Therapy for Infective Endocarditis
