Clinical implementation of partial oral treatment in infective endocarditis: the Danish POETry study

In this study (n=562) patients were allocated to step-down oral antibiotic or continued IV treatment. Patients were followed up for 6 months for embolic events, unplanned cardiac surgery, relapse or death which were shown to occur in 13% & 18% respectively (p=0.051).

SPS commentary:

Additionally, it is reported that 8% of the orally treated group died compared with 14% of the IV group and that the orally treated group had a shorter median hospital stay (24 days vs 43 days). However, is noted that more patients in the IV group had an infection due to S. aureus, intra-cardiac abscess or a pacemaker and more were surgically treated and therefore were at increased risk of negative outcomes and the advantages reported may to some extent reflect selection bias and unmeasured confounding. That said it is noted that almost half the patients assessed were able to receive oral step-down antibiotic therapy, so clinical implementation seems feasible and safe.

European Heart Journal