Reducing Hospital Stays in Infective Endocarditis


Patients with infective endocarditis on the
left side of the heart are typically treated with intravenous antibiotic agents for up
to 6 weeks. During the initial phase of hospitalization
and treatment, patients often require intensive care and close monitoring. After this period, many patients remain hospitalized
to complete intravenous antibiotic treatment. In this randomized, noninferiority trial,
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 were randomized to continue intravenous treatment
or to switch to oral antibiotic treatment. In all patients, antibiotic treatment was
administered intravenously for at least 10 days. The primary outcome was 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. In the intravenously treated group, the primary
outcome occurred in 24 patients, as compared with 18 patients in the orally treated group,
with a between group difference of 3.1 percentage points that met noninferiority criteria. This trial showed that in medically stable
patients who had endocarditis on the left side of the heart cause by streptococcus,
E. faecalis, S. aureus, or coagulase-negative staphylococci, a transition from intravenously
administered to orally administered antibiotics was noninferior to continued intravenous antibiotic
therapy. Full trial results are available at NEJM.org.

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