Partial Oral Antibiotic Therapy for Endocarditis: 2023 ESC Framework Reviewed

This practical review synthesizes the POET trial, 2023 ESC Guidelines, WikiGuidelines, and SPILF-AEPEI guidance into a bedside framework for oral step-down antibiotic therapy in left-sided infective endocarditis.

POET trial2023 ESC GuidelinesWikiGuidelinesSPILF-AEPEIEuropean Society of Cardiologyinfective endocarditispartial oral antibiotic therapyoral step-downbeta-lactamsfluoroquinoloneslinezolidrifampicinantibiotic stewardship Infectious Disease / Antimicrobials

Background Information

POAT reduces hospital stay and mortality in selected IE patients.

Partial oral antibiotic therapy (POAT) for infective endocarditis (IE) offers a viable alternative to prolonged intravenous (IV) antibiotic therapy, potentially reducing hospital stay and associated complications. The Partial Oral Treatment of Endocarditis trial showed POAT after at least 10 days of IV therapy is non-inferior to continued IV treatment with lower all-cause mortality over 5.4 years. Recent guidelines endorse POAT for selected patients with IE, supported by randomized and real-world evidence. This approach may not cover all eligible patients yet, underscoring the need for stringent patient selection and follow-up. POAT is an effective and recommended option for eligible infective endocarditis patients, reducing IV therapy duration.

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Executive Summary

Study Design

Patient Population

Primary Outcomes

Secondary Outcomes & Safety Profile

Pharmacist Implications

Clinical Pearls

Limitations

Controversies & Evidence Gaps

Cost & Logistics

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