Hospital discharge with oral antibiotics safe for stable endocarditis
Patients hospitalized with endocarditis can be safely switched from intravenous antibiotics to oral medication about halfway through the course of treatment, according to a randomized trial published in the New England Journal of Medicine. The finding suggests stable patients could be discharged much earlier, saving money for hospitals and patients while potentially reducing the risk of hospital-acquired medical conditions.
The multicenter Danish trial enrolled 400 patients with endocarditis who were considered to be in stable condition after receiving at least 10 days of IV antibiotics. Participants were randomized 1:1 to either continue receiving IV antibiotics or to oral antibiotics, which meant they were given the option to be treated as outpatients.
After randomization, patients continued on antibiotics for a median of 18 days. Over a six-month follow-up period, researchers tracked the occurrence of the composite primary outcome of all-cause mortality, unplanned cardiac surgery, embolic events or reinfection with the same primary pathogen.
Nine percent of patients in the orally treated group met that outcome during follow-up, compared to 12.1 percent of patients in the IV-treated group. The median hospital length of stay after randomization was three days in the oral group and 19 days in the IV group.
“It is a huge challenge for patients to stay in hospital for up to six weeks receiving intravenous treatment, which is associated with an increased risk of complications,” lead author Henning Bundgaard, MD, said in a press release issued by the European Society of Cardiology (ESC). The results were presented at the ESC Congress in Munich on the same day it was published in NEJM.
“Reducing the length of hospital stay has improved outcomes in other diseases and oral antibiotics could be a safe way to achieve this,” the authors wrote.
Endocarditis is an infection of the inner lining of the heart and one or more of its valves. It is associated with an in-hospital mortality rate ranging from 15 to 30 percent, but most complications occur soon after admission, according to the authors.
“For a large proportion of patients, the main reason for staying in the hospital after the initial phase is to complete intravenous antibiotic treatment,” which can last up to six weeks, the authors noted.
But this study suggests stable patients can be administered oral antibiotics for roughly half that period without increasing the risk for adverse outcomes. Results were consistent across various subgroups, including the type of bacterial infection and whether a native or prosthetic valve was affected.
“These novel findings may have a significant impact on future clinical practice,” Bundgaard said.
Daniel joined TriMed’s Chicago editorial team in 2017 as a Cardiovascular Business writer. He previously worked as a writer for daily newspapers in North Dakota and Indiana.