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BMC Infect Dis. 2014 Mar 13;14:140. doi: 10.1186/1471-2334-14-140.

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

Author information

1
Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada. vcorrales@toh.on.ca.

Abstract

BACKGROUND:

The role of oral antibiotic therapy in treating infective endocarditis (IE) is not well established.

METHODS:

We searched MEDLINE, EMBASE and Scopus for studies in which oral antibiotic therapy was used for the treatment of IE.

RESULTS:

Seven observational studies evaluating the use oral beta-lactams (five), oral ciprofloxacin in combination with rifampin (one), and linezolid (one) for the treatment of IE caused by susceptible bacteria reported cure rates between 77% and 100%. Two other observational studies using aureomycin or sulfonamide, however, had failure rates >75%. One clinical trial comparing oral amoxicillin versus intravenous ceftriaxone for streptococcal IE reported 100% cure in both arms but its reporting had serious methodological limitations. One small clinical trial (n = 85) comparing oral ciprofloxacin and rifampin versus conventional intravenous antibiotic therapy for uncomplicated right-sided S. aureus IE in intravenous drug users (IVDUs) reported cure rates of 89% and 90% in each arm, respectively (P =0.9); however, drug toxicities were more common in the latter group (62% versus 3%; P <0.01). Major limitations of this trial were lack of allocation concealment and blinding at the delivery of the study drug(s) and assessment of outcomes.

CONCLUSION:

Reported cure rates for IE treated with oral antibiotic regimens vary widely. The use of oral ciprofloxacin in combination with rifampin for uncomplicated right-sided S. aureus IE in IVDUs is supported by one small clinical trial of relatively good quality and could be considered when conventional IV antibiotic therapy is not possible.

PMID:
24624933
PMCID:
PMC4007569
DOI:
10.1186/1471-2334-14-140
[Indexed for MEDLINE]
Free PMC Article

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