Patients with infective endocarditis who transitioned from intravenous to oral antibiotics had comparable outcomes to those receiving intravenous-only therapy, while spending significantly more time outside the hospital, according to a French cohort study published in Clinical Infectious Diseases.
The oral switch group had a 10% treatment failure rate compared with 20% in the intravenous-only group, with no statistically significant difference after adjustment for patient characteristics. Patients who switched to oral therapy spent a median of 59 days alive and outside the hospital in the 90 days following treatment initiation, compared with 47 days for the intravenous group.
Importantly, outcomes remained comparable even among patients who would not have been eligible for the landmark POET trial, which included 45% of study participants. This suggests oral switch therapy may benefit a broader population than previously demonstrated.
The study revealed common oral regimens included fluoroquinolone plus rifampicin for Staphylococcus aureus infections and amoxicillin monotherapy for Streptococcus infections. Notably, 57% of patients who remained on intravenous-only therapy were actually POET-eligible, suggesting oral switch remains underutilized even among ideal candidates
Researchers analyzed 333 patients with definite infective endocarditis treated at two university hospitals in France between 2016 and 2023. Of these patients, 233 received intravenous-only treatment and 100 transitioned to oral therapy. The median age was 71 years, and 70% were male, with left-sided infections accounting for 84% of cases.
However, patients who transitioned to oral therapy earlier than 10 days following the start of intravenous treatment had higher rates of treatment failure compared with those who switched later, suggesting timing remains critical.
“This finding held true even after propensity score weighting and in patients who would not have been eligible for the POET trial,” wrote Benoit Rallet, MD, of Dijon Bourgogne University Hospital, and colleagues.
The study was limited by its retrospective design and lack of standardized treatment protocols. Patients with vascular prosthesis infections or resistant pathogens were less likely to receive oral therapy. Researchers noted that further prospective trials are needed to confirm the safety of oral therapy in more complex populations.
The authors reported no conflicts of interest.
Source: Clinical Infectious Diseases
