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10.02.2020 | review article Open Access

Partial oral antibiotic therapy is non-inferior to intravenous therapy in non-critically ill patients with infective endocarditis

Review and meta-analysis

Zeitschrift:
Wiener klinische Wochenschrift
Autoren:
M.D. Richard Rezar, M.D. Peter Jirak, M.D. Ph.D. Assoc.-Prof. Michael Lichtenauer, M.D. Ph.D. Prof. Christian Jung, M.D. Prof. Alexander Lauten, M.D. Prof. Uta C. Hoppe, M.D. Bernhard Wernly
Wichtige Hinweise

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All data relevant for this study will be given by the authors upon specific request without restriction.

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Summary

Background

Antimicrobial therapy is a cornerstone in the treatment of infective endocarditis (IE). Typically, intravenous (i.v.) therapy is given for 6 weeks or longer, leading to prolonged hospital stays and high costs. Several trials evaluating the efficacy of partial oral therapy (POT) have been published. This article aimed to review and meta-analyze studies comparing i.v. therapy versus POT in non-critically ill patients suffering from IE.

Methods

A structured database search (based on PRISMA guidelines) regarding POT versus i.v. therapy in IE was conducted using PubMed/Medline. Primary endpoint was all-cause mortality and a secondary endpoint IE relapse. Risk rates were calculated using a random effects model (DerSimonian and Laird). Heterogeneity was assessed using the I2 statistics.

Results

After screening 1848 studies at title and abstract levels, 4 studies were included. A total of 765 patients suffered from primary left-sided IE, whereas right-sided IE was observed in 72 patients. Mortality rates were lower in POT versus i.v. therapy (risk ratio [RR] 0.38, 95% confidence interval, confidence interval [CI] 0.20–0.74; p = 0.004; I2 0%). IE relapse rates were similar (RR 0.63, 95% CI 0.29–1.37; p = 0.24; I2 0%).

Conclusion

Data comparing POT with standard care in IE is limited and to date only one sufficiently powered stand-alone trial exists to support its use. In this meta-analysis POT was non-inferior to i.v. therapy with respect to mortality and IE relapse in non-critically ill patients suffering from both left-sided and right-sided IE. These findings indicate that POT is a feasible treatment strategy in selected patients suffering from IE but further validation in future studies will be required.

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