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Table 2 Clinical trials of oral antibiotic therapy for infective endocarditis

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

Reference Cases Design Case definition Microbiology Therapy Results
Heldman et al, USA [18] 85 IVDUs with NVIE (all right-sided with no systemic metastases), 40 in the oral therapy arm and 45 in the IV therapy arm Prospective, randomized, open label. 1-month follow-up - ≥2 positive blood cultures AND any of the following: Valvular vegetations on echocardiogram (definite – 15 cases) OR evidence of pulmonary emboli on chest X-ray or tricuspid insufficiency murmur (probable – 26 cases) OR no other identifiable source for the infection (possible – 44 cases) MRSA (5%) MSSA (89%) CoNS (6%) Oral ciprofloxacin and rifampin for 4 weeks vs. IV oxacillin or vancomycin (IV gentamicin for the first 5 days) for 4 weeks Cure rate: 90% (oral therapy) vs. 91% (IV therapy), p = 0.9
Treatment toxicity: 3% (oral therapy) vs. 62% (IV therapy), p < 0.001
Stamboulian et al, Argentine [19] 30 NVIE (all left-sided), 15 in each arm Prospective, randomized, open label. 3 to 6-motnh follow-up - ≥2 positive blood cultures AND any of the following: New or changing regurgitant murmur OR predisposing heart disease OR vascular phenomena OR valvular vegetation on echocardiogram S. viridans (50%) IV or IM ceftriaxone for 2 weeks followed by high dose oral amoxicillin for 2 weeks vs. IV or IM ceftriaxone for 4 weeks Cure rate: 100% in both arms. Treatment toxicity not reported
S. bovis (50%)
  1. NVIE denotes cases of native valve infective endocarditis. IV denotes intravenous. IM denotes intramuscular. IVDUs denotes intravenous drug users. MSSA denotes methicillin-sensitive S. aureus. MRSA denotes methicillin-resistant S. aureus. CoNS denotes coagulase-negative staphylococcus. All reports reported follow-up ≥2 months.