Partial Oral Therapy for Infective Endocarditis Among Adult Infectious Diseases Physicians in the United States: An Emerging Infections Network Survey - Scorecard - MDSpire
Advertisement
Partial Oral Therapy for Infective Endocarditis Among Adult Infectious Diseases Physicians in the United States: An Emerging Infections Network Survey
Clinical Scorecard: Survey of Adult Infectious Diseases Physicians in the U.S. on the Use of Partial Oral Therapy for Infective Endocarditis: Insights from the Emerging Infections Network
At a Glance
Category
Detail
Condition
Infective Endocarditis (IE)
Key Mechanisms
Partial oral therapy (POT) following initial intravenous antimicrobial treatment to reduce IV therapy duration
Target Population
Adult patients with infective endocarditis, including subsets with Streptococcus spp., Gram-negative bacilli, and people who inject drugs (PWID)
Care Setting
Hospital and outpatient settings, including outpatient parenteral antimicrobial therapy (OPAT) programs
Key Highlights
Partial oral therapy (POT) for IE is infrequently used by U.S. adult infectious diseases physicians, with 53% using it in ≤10% of cases.
Comfort with POT varies by pathogen: 66% for Streptococcus spp., 52% for Gram-negative bacilli, and 19% for MRSA.
Leading barriers to POT adoption include fear of relapse (72%), adherence concerns (53%), and insufficient evidence (48%).
Guideline-Based Recommendations
Diagnosis
Confirm IE diagnosis with standard clinical and microbiological criteria before considering POT.
Management
Consider POT after a minimum of 10 days of intravenous therapy and clinical stability, per 2023 ESC guidelines (Class IIa recommendation).
Use POT cautiously in select patients, especially those with left-sided IE, excluding MRSA and immunocompromised patients as per current evidence.
In PWID, POT may be practical in select cases as noted in 2022 AHA Scientific Statement.
Monitoring & Follow-up
Ensure strict stability criteria are met before switching to oral therapy.
Monitor adherence closely due to concerns about relapse and treatment failure.
Risks
Potential for relapse if oral therapy is initiated prematurely or in inappropriate patients.
Adherence challenges with oral regimens may compromise treatment efficacy.
Patient & Prescribing Data
Adult patients with infective endocarditis managed by infectious diseases physicians in the U.S.
POT is used sparingly; higher usage correlates with higher IE caseload and fewer years in clinical practice. Single-agent oral therapy is common among those using POT.
Clinical Best Practices
Select patients carefully for POT based on pathogen, clinical stability, and ability to adhere to oral regimens.
Prioritize availability of active oral agents and pathogen identification in decision-making.
Advocate for clearer guidelines and additional clinical trial data to support POT use.
Expand access to complex outpatient antimicrobial therapy services to facilitate POT adoption.
