Oral antibiotic therapy for the treatment of infective endocarditis: a systematic review

Abstract

BackgroundThe role of oral antibiotic therapy in treating infective endocarditis (IE) is not well established.MethodsWe searched MEDLINE, EMBASE and Scopus for studies in which oral antibiotic therapy was used for the treatment of IE.ResultsSeven observational studies evaluating the use oral beta-lactams (five), oral ciprofloxacin in combination with rifampin (one), and linezolid (one) for the treatment of IE caused by susceptible bacteria reported cure rates between 77% and 100%. Two other observational studies using aureomycin or sulfonamide, however, had failure rates >75%. One clinical trial comparing oral amoxicillin versus intravenous ceftriaxone for streptococcal IE reported 100% cure in both arms but its reporting had serious methodological limitations. One small clinical trial (n = 85) comparing oral ciprofloxacin and rifampin versus conventional intravenous antibiotic therapy for uncomplicated right-sided S. aureus IE in intravenous drug users (IVDUs) reported cure rates of 89% and 90% in each arm, respectively (P =0.9); however, drug toxicities were more common in the latter group (62% versus 3%; P <0.01). Major limitations of this trial were lack of allocation concealment and blinding at the delivery of the study drug(s) and assessment of outcomes.ConclusionReported cure rates for IE treated with oral antibiotic regimens vary widely. The use of oral ciprofloxacin in combination with rifampin for uncomplicated right-sided S. aureus IE in IVDUs is supported by one small clinical trial of relatively good quality and could be considered when conventional IV antibiotic therapy is not possible.

2015 ESC Guidelines for the management of infective endocarditis

“…Alternatywnie, kiedy dożylna droga podania leków nie jest możliwa, IZW prawej części serca spowodowane przez S. aureus można leczyć doustną ciprofloksacyną (750 mg 2 razy dziennie) z rifampicyną (300 mg 2 razy dziennie), pod warunkiem, że szczep bakterii jest w pełni wrażliwy na oba leki, a stosowanie się pacjenta do zaleceń ściśle monitorowane [439]. Na podstawie wyników randomizowanego kontrolowanego badania wykazano, że zastosowanie daptomycyny nie jest gorsze niż standardowe leczenie zakażeń wywołanych S. aureus, w tym prawostronnego IZW [168].…”

Haemophilus parainfluenzae aortic prosthetic valve endocarditis (PVE) successfully treated with oral levofloxacin

“…9 The gradual introduction of IV to PO switch programs for a variety of serious systemic infections has led to increased use of oral antimicrobial therapy including treatment of IE. 9,12 Most widely used has been oral therapy of tricuspid valve (TV) ABE in intravenous drug abusers (IVDAs) due to methicillin resistant S. aureus (MRSA) or methicillin sensitive S. aureus (MSSA). 13 IVDAs with TV MSSA/MRSA have been treated entirely by the oral route for a short duration (2 weeks) by us and others.…”

“…1,4 As experience and confidence has increased over the years, there have been more reports of cases of serious infections treated via the oral route, including IE. 9 At the present time, there are several antibiotics available that meet criteria to treat IE, i.e., bactericidal, with same blood and tissue (cardiac valve/vegetation) levels as their parenteral counterparts. For the treatment of IE oral antibiotics used should have a high degree of activity against the IE pathogen and bioavailability, i.e., >90% gastrointestinal absorption to achieve serum and tissue levels which are essentially the same as their IV equivalent.…”

“…1e8 Rarely, PVE has been cured with antimicrobial therapy (IV/ PO) alone without valve replacement. 9 Infectious disease and cardiology groups have developed endocarditis treatment guidelines that recommend intravenous (IV) antibiotics for 4e6 weeks for IE. 4e8 …”

PICC Your Battles: Considering the Appropriateness of Peripherally Inserted Central Catheter (PICC) Lines for Outpatient Parenteral Antimicrobial Therapy (OPAT) in Injection Drug Users (IDUs)

“…Honest and straightforward conversations must be held between patients and providers regarding the importance of keeping the PICC line as clean as possible, given its indwelling nature and the increased risk of endocarditis in IDUs. If patients plan or believe they might use the PICC line for injecting drugs, oral antibiotic alternatives may be tried with the understanding that they may be less effective [6,8,12]. Patients can also be encouraged to inject more safely by cleaning the site adequately, using sterile water to mix with their drugs, using new needles each time, and not sharing paraphernalia [13].…”