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Patients with an infection of the left lining of the heart (endocarditis) who have switched from intravenous antibiotic therapy to oral antibiotic therapy have better long-term survival and fewer complications than similar patients who remained under Conventional intravenous antibiotic therapy, according to research presented at the American College of Cardiology & # 39; s 68th Annual scientific session.
While the initial six-month data had shown that partial treatment with oral antibiotics was similar in efficacy and safety to conventional intravenous treatment of infective endocarditis on the left side, a longer follow-up (median 3.5 years ) shows that this therapeutic approach is better for patients, Henning Bundgaard, MD, Ph.D., DMSc, professor of cardiology at the Heart Center of the National University Hospital in Copenhagen, Denmark, and lead author of the 39; study.
"In stabilized patients with infective endocarditis on the left side, switching from intravenous antibiotics to oral antibiotics has shown superior efficacy and safety compared to continuous intravenous therapy," he said. declared. "These results clearly support a change in the standard of care for this condition."
People with pre-existing cardiac valve disease, anterior endocarditis, prosthetic heart valves or other implanted cardiac devices have a high risk of infectious endocarditis. The disease most often occurs on the left side of the heart in the mitral or aortic valve. Infectious endocarditis is diagnosed about twice as often in men as in women.
The present study, called POET, is the largest randomized study in patients with infectious endocarditis. It aimed to determine whether oral antibiotic therapy for infective endocarditis on the left side was at least as effective and safe as intravenous treatment.
The clinical guidelines of several professional organizations currently recommend treating infective endocarditis on the left side with intravenous antibiotics for up to six weeks. During the initial phase of treatment, patients often require intensive care and close supervision. Because intravenous antibiotics are difficult to administer outside a hospital, most patients stay in the hospital for the duration of their treatment.
Studies have suggested that intravenous treatment during long stays in the hospital could increase the risk of complications in patients. Oral antibiotics would allow patients to leave the hospital earlier and complete their home treatment. Studies in other conditions have shown that patients with a shorter hospital stay generally had better results.
In total, 400 patients (mean age 67 years; 77% men) with infectious endocarditis on the left side were included in the study. The study participants had to be in stable condition and have achieved a satisfactory response to intravenous antibiotic treatment at least 10 days before randomization. They were then randomly badigned to continue with intravenous antibiotics or to switch to oral therapy for an average of 17 days after diagnosis. Patients treated intravenously remained in the hospital until the end of their antibiotic treatment. Patients who switched to oral therapy left the hospital three days after the change.
The primary endpoint of the study was a composite of all-cause death, unplanned cardiac surgery, embolic events (eg, stroke) and relapse. infection by the same pathogen from the moment of randomization until the end of the follow-up.
After a median follow-up of 3.5 years, 53 patients (26.4%) in the group receiving partial oral treatment had a primary endpoint, compared to 76 patients (38.2%) in the intravenous group, statistically different. significant. Eighty-seven patients died; of these, 54 (27.1%) were treated intravenously and 33 (16.4%) were treated with oral medications, a significant difference. No significant difference in outcome was observed in case of relapse of infection, unplanned cardiac surgery or embolic events. The importance of the difference between the two groups is sufficient to conclude that oral treatment is superior to intravenous treatment, Bundgaard said.
According to Bundgaard, only patients with infective endocarditis on the left side caused by certain bacterial species were recruited. The results may not be applicable to approximately 25% of patients whose conditions are caused by other bacteria. In addition, although patients with antibiotic-resistant bacteria were not excluded from the trial, none were enrolled. Bundgaard and colleagues plan to conduct additional badyzes to compare quality of life and treatment costs in groups receiving intravenous or partial oral therapy.
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