Long-Term Outcomes of Partial Oral Treatment of Endocarditis

Bundgaard, Henning; Ihlemann, Nikolaj; Gill, Sabine; Bruun, Niels Eske; Elming, Hanne; Madsen, Trine; Jensen, Kimmo; Fursted, Kurt; Christensen, Jens Jørgen; Schultz, Martin; Østergaard, Lauge; Rosenvinge, Flemming Schønning; Schønheyder, Henrik Carl; Helweg‐Larsen, Jannik; Fosbøl, Emil Loldrup; Køber, Lars; Torp‐Pedersen, Christian; Tønder, Niels; Moser, Claus; Iversen, Kasper

doi:10.1056/nejmc1902096

Cited by 58 publications

(44 citation statements)

References 5 publications

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“…A subsequent analysis at 3.5 years showed similar results. 18,19 Important caveats on these results included the heterogeneity in the bacterial pathogens being treated and the antibiotic combinations used and the lack of infections with multiresistant organisms. Few patients had cardiac devices or were injecting drug users.…”

Section: Articlementioning

confidence: 99%

Oral or intravenous antibiotics?

McCarthy¹,

Avent²

2020

Aust Prescr

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Intravenous antibiotics are overused in hospitals. Many infections can be managed with oral antibiotics.Oral antibiotics avoid the adverse effects of intravenous administration. They are also usually less expensive.When intravenous antibiotics are indicated, it may be possible to switch to oral therapy after a short course. There are guidelines to aid the clinician with the timing of the switch so that there is no loss of efficacy.Infections that may be suitable for a short course of intravenous antibiotic include pneumonia, complicated urinary tract infections, certain intra-abdominal infections, Gram-negative bacteraemia, acute exacerbations of chronic lung disease, and skin and soft tissue infections.Bone and joint infections and infective endocarditis are managed with prolonged courses of intravenous antibiotics. However, there is research looking at the feasibility of an earlier switch to oral antibiotics in these conditions. third of almost 2000 days of antibiotic therapy was unnecessary. 3 Using oral rather than parenteral antibioticsMajor advantages of oral over the intravenous route are the absence of cannula-related infections or thrombophlebitis, a lower drug cost, and a reduction in hidden costs such as the need for a health professional and equipment to administer intravenous antibiotics. Oral therapy may potentially enable an early discharge from the hospital 4,5 or directly from the emergency department. 6 For example, a single dose of intravenous antibiotic for paediatric uncomplicated urinary tract infections did not reduce the rate of representation or readmission. This suggests most children with a urinary tract infection can be managed with oral antibiotics alone. 7 A key consideration is the bioavailability of oral antibiotics. This varies in comparison to intravenous formulations (Tables 1 and 2). Some oral antibiotics have equivalent bioavailability to the intravenous drug. They could be substituted, depending on the condition being treated and the required site of drug penetration.In a small prospective trial, patients with moderately severe cellulitis were randomised to receive either oral cefalexin monohydrate or parenteral cefazolin. Parenteral administration was changed to oral once the cellulitis had stopped progressing and the patient was afebrile. There was no statistically significant REFERENCES

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Section: Articlementioning

confidence: 99%

Oral or intravenous antibiotics?

McCarthy¹,

Avent²

2020

Aust Prescr

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“…In their study, Bundgaard et al reported that in the longterm POET follow-up, at a median of 3.5 years, the primary outcome had occurred in 26.4% of the oral antibiotics group compared with 38.2% of the intravenous antibiotics group (p=0.01). 3 Interestingly, all-cause mortality at the end of follow-up was 16.4% in the oral antibiotics group versus 27.1% in the intravenous antibiotics group (p<0.05). The results of this trial might ultimately reduce hospital length of stay as well as peripherally inserted central catheter-related complications.…”

Section: Poet Long-term Follow-upmentioning

confidence: 90%

Major Cardiovascular Advances: Highlights from the 2019 American College of Cardiology Annual Scientific Session

Badreldin

Saleh

Yami

2020

US Cardiology Review

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The 69th American College of Cardiology Annual Scientific Session and Expo was held in New Orleans, Louisiana on March 16–18, 2019. For many years this meeting has gathered together an enormous number of participants, abstracts, oral presentations, poster presentations, educational sessions, late-breaking clinical trial results, and clinical practice guidelines under one roof. The authors have selected and summarized the key points from a number of key landmark trials, featured clinical research results and clinical practice guidelines that were presented during this year’s meeting.

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“…There are, fortunately, also biofilm infections where antibiotic prophylactics and treatment are not so difficult e.g. endocarditis and successful antibiotic treatment can be obtained, even with orally administered antibiotics in stabilized patients after an initial intravenous course of appropriate antibiotic drugs .…”

Section: Special Situation Biofilm Infectionsmentioning

confidence: 99%

Antibiotic therapy as personalized medicine – general considerations and complicating factors

Moser

Lerche

Thomsen

et al. 2019

APMIS

Self Cite

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The discovery of antibiotic drugs is considered one of the previous century's most important medical discoveries (Medicine's 10 greatest discoveries. New Haven, CT: Yale University Press, 1998: 263). Appropriate use of antibiotics saves millions of lives each year and prevents infectious complications for numerous people. Still, infections kill unacceptable many people around the world, even in developed countries with easy access to most antibiotic drugs. Optimal use of antibiotics is dependent on the identification of primary and secondary focus, and knowledge on which pathogens to expect in a specific infectious syndrome and information on general patterns of regional antibiotic resistance. Furthermore, sampling for microbiological analysis, knowledge of patient immune status and organ functions, travel history, pharmacokinetics and ‐dynamics of the different antibiotics and possible biofilm formation are among several factors involved in antibiotic therapy of infectious diseases. The present review aims at describing important considerations when using antibacterial antibiotics and to describe how this is becoming substantially more personalized. The parameters relevant in considering the optimal use of antibiotics to treat infections are shown in Fig. 1 – leading to the most relevant antibiotic therapy for that specific patient. To illustrate this subject, the present review's focus will be on challenges with optimal dosing of antibiotics and risks of underdosing. Especially, in cases highly challenging for achieving the aimed antibiotic effect against bacterial infections – this includes augmented renal clearance (ARC) in sepsis, dosing challenges of antibiotics in pregnancy and against biofilm infections.

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Long-Term Outcomes of Partial Oral Treatment of Endocarditis

Cited by 58 publications

References 5 publications

Oral or intravenous antibiotics?

Oral or intravenous antibiotics?

Major Cardiovascular Advances: Highlights from the 2019 American College of Cardiology Annual Scientific Session

Antibiotic therapy as personalized medicine – general considerations and complicating factors

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