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%) |