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Open Access Highly Accessed Research article

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

Awad Al-Omari1, D William Cameron234, Craig Lee24 and Vicente F Corrales-Medina2345*

Author Affiliations

1 Department of Medicine, Security Forces Hospital, Riyadh, Saudi Arabia

2 Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada

3 The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

4 The Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada

5 1053 Carling Ave, ASB 2003, Ottawa, Ontario K1Y 4E9, Canada

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BMC Infectious Diseases 2014, 14:140  doi:10.1186/1471-2334-14-140

Published: 13 March 2014

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.

Keywords:
Endocarditis; Treatment; Outcomes; Oral antibiotic therapy