A Danish, multicenter, randomized POET trial revealed that after declared clinically stable on taking intravenous antibiotics in a hospital for one to two weeks, left-sided endocarditis patients could be sent home with a prescription of antibiotics to be taken orally to complete the rest of the treatment.
“Shifting to oral antibiotic treatment in stabilized patients with endocarditis was as effective and safe as continued intravenous antibiotic treatment and was given during half the antibiotic treatment period. These novel findings may have a significant impact on future clinical practice for the management of patients who are stable,” Henning Bundgård, MD, said at the annual congress of the European Society of Cardiology.
Guiding principles from the ESC and American Heart Association/American College of Cardiology suggest 6 weeks of intravenous antibiotics for the management of infective endocarditis. This reduces the stay in the hospital to half resulting in lowering of the expenses borne by the patient and also enhances his/her quality of life, said Dr. Bundgård, a cardiologist at Copenhagen University Hospital.
The POET (Partial Oral Treatment of Endocarditis) trial was conducted after analysts found that a huge chunk of grave complications are seen only in the beginning of the vital phase of the treatment course, i.e. about 10 days of intravenous antibiotic administration, not forgetting the 15% mortality rate of in-patients suffering from infective endocarditis
“After stabilization, the main reason for staying in the hospital is just to receive IV antibiotics,” Dr. Bundgård noted.
400 in-patients having left-sided endocarditis from different cardiac centers in Denmark, among whom 35% also had a comorbid condition, were included in the POET.To declare a patient clinically stable, he/she had to be afebrile, and have 35% lower than maximum levels C-reactive protein and leukocytes, and had undergone intravenous antibiotic therapy for at least 10 days, as clarified by Dr. Bundgård.
He explained that oral therapy was chosen over intravenous antibiotics for home treatment as intravenous antibiotic therapy wasn’t popular in Denmark due to its cost and complicated logistics.
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