Response-Tailored or Standard-Duration Antibiotic Treatment for Infective Endocarditis.
Henning Bundgaard, Mia Pries-Heje, Julie Hjulmand et al.
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In 30 seconds
This international, open-label randomized trial compared response-tailored with standard-duration antibiotic therapy in clinically stable adults with left-sided infective endocarditis caused by Staphylococcus aureus, Enterococcus faecalis, or streptococci. After at least 2 to 4 weeks of treatment, 508 patients were randomized. Tailored therapy increased median days alive without antibiotics through 6 months (183 vs 169 days; estimated difference, 13 days; 95% CI, 12 to 13) and met the prespecified safety noninferiority criterion. However, relapse was more frequent with tailored therapy (5.1% vs 1.6%).
Key findings
- Median time alive without antibiotic treatment was 183 days with tailored therapy and 169 days with standard therapy; estimated difference, 13 days (95% CI, 12 to 13).
- The primary safety outcome occurred in 8.2% with tailored therapy and 10.7% with standard therapy; the result met the noninferiority criterion.
- Relapse of bacteremia or endocarditis occurred in 13 patients (5.1%) with tailored therapy and 4 (1.6%) with standard therapy (P = 0.04).
Why it matters
The trial suggests that, in selected clinically stable patients with left-sided infective endocarditis, antibiotic duration can be individualized after an initial treatment period while preserving the trial’s defined safety outcome. The higher relapse incidence is an important counterweight: reduced antibiotic exposure and the composite safety result should not be interpreted as evidence that relapse risk is unchanged.
What to keep in mind
The open-label trial enrolled clinically stable adults with specified pathogens after at least 2 to 4 weeks of therapy; its findings do not establish applicability to other patient groups or treatment circumstances.