ACC 2019 | POET: Oral Antibiotics with Good Long-Term Results for Endocarditis

This work found better survival rates with oral treatment, an outcome that may be credited to shorter hospital stays and the subsequent reduction of complications related to them.

A strategy of switching to oral treatment after a short intravenous (IV) regimen confers long-term safety and efficacy. These data are derived from an exploratory analysis of the POET trial.

This might allow many patients to go home earlier with a survival advantage derived from avoiding all hospital-associated complications.

The main author of this work presented at the American College of Cardiology [ACC] 2019 Scientific Session (and simultaneously published in the New England Journal of Medicine [NEJM]) suggested that oral antibiotics may safely be administered during approximately half the recommended antibiotic treatment period, thus reducing by half the length of hospital stay.

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Oral treatment and early discharge home may be an appropriate strategy in up to 50% of patients.

The POET trial randomized patients with left-sided endocarditis who were hospitalized in Denmark sites and had been receiving IV treatment. Patients were randomized on day 10 to either continue IV therapy (n = 199) or switch to oral antibiotics (n = 201) and discharge to outpatient follow-up.

Half of patients had aortic valve endocarditis, about one-third had mitral endocarditis, and about 10% had endocarditis in both valves.

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The most frequent pathogens were streptococci, followed by Staphylococcus aureus, Enterococcus faecalis, and coagulase-negative staphylococci.

About one quarter of patients with aortic valve disease had developed an infection in a previously implanted prosthetic valve.

At 6 months, all-cause mortality, unplanned surgery, clinical signs of embolic events, or relapse of bacteremia with the identified pathogen had occurred in 12.1% of patients with IV treatment and in 9.0% of patients with oral treatment (odds ratio [OR]: 0.72; 95% confidence interval [CI]: 0.37-1.36).

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After a 3.5-year follow-up, the safety and efficacy of the oral strategy were maintained.

The primary endpoint occurred in 38.2% of patients who received IV treatment and in 26.4% of patients who received oral treatment (hazard ratio [HR]: 0.64; 95% CI: 0.45-0.91).

There were no significant differences regarding the components of the primary endpoint with the exception of long-term survival, which was superior with oral treatment (16.4% vs. 27.1%; P = 0.009).

Original title: Long-Term Outcomes of Partial Oral Treatment of Endocarditis.

Reference: Bundgaard H et al. N Engl J Med. 2019; Epub ahead of print.

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