- Question
- In stable patients with left-sided infective endocarditis, can a switch from intravenous to oral antibiotics achieve efficacy and safety similar to continued intravenous treatment?
- Design
- Multicenter, randomized, open-label (no masking), noninferiority trial in which 400 adults were assigned to continue intravenous treatment (199) or switch to oral treatment (201). Follow-up lasted 6 months after completion of antibiotic treatment.
- Population
- Adults in stable condition with left-sided endocarditis caused by streptococcus, Enterococcus faecalis, Staphylococcus aureus or coagulase-negative staphylococci who were already receiving intravenous antibiotics.
- Intervention
- Switch to oral antibiotics chosen according to the resistance pattern, after at least 10 days of intravenous treatment; when feasible, patients were discharged to outpatient care.
- Control
- Continued guideline-based intravenous antibiotic treatment.
- Primary outcome
- Composite of all-cause mortality, unplanned cardiac surgery, embolic events, or relapse of bacteremia with the primary pathogen, from randomization until 6 months after completion of antibiotic treatment.
- Results
- The primary outcome occurred in 24 patients (12.1%) in the intravenous group and 18 (9.0%) in the oral group (between-group difference, 3.1 percentage points; 95% CI, -3.4 to 9.6; P=0.40), meeting the noninferiority criteria. Antibiotic treatment was completed after a median of 19 days in the intravenous group and 17 days in the oral group (P=0.48).
- Conclusion
- In stable patients with left-sided endocarditis, switching to oral antibiotics was noninferior to continued intravenous treatment.
- Why it matters
- It showed that a partially oral strategy is a valid alternative to prolonged intravenous regimens, opening the door to shorter hospital stays and outpatient completion of treatment in selected patients.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026