Switching from intravenous to oral antibiotic therapy in the treatment of infective endocarditis: a case series and literature review of real-world data

Background: The POET trial, along with other studies, indicated that switching from IV to partial oral treatment (POT) in selected infective endocarditis (IE) cases is as effective as the traditional 4-6 weeks of IV therapy. This evidence supported the inclusion of POT in the 2023 European Society of Cardiology (ESC) guidelines, although real-world data remain limited. Methods: This study retrospectively reviewed IE patients at ASST Santi Paolo e Carlo in Milan, Italy, from January 2018 to July 2022, to identify those who switched to POT. Additionally, a literature review was conducted using PubMed to gather real-world data up to October 2024. Results: Among 136 IE patients treated at our institution, 9 switched from IV antibiotic therapy to POT. The switch was driven by factors such as lack of venous access, patient preference or improved adherence, and IV antibiotic toxicity. All patients who underwent POT recovered, with no in-hospital or 1 month post-discharge deaths. The literature review uncovered 8 observational studies, 3 case series and 10 case reports, which overall support the effectiveness and safety of POT in selected IE cases, while also highlighting benefits like reduced hospital stays, lower treatment costs and fewer IV-related complications. Conclusions: In a real-world setting, stepping down to POT after an initial IV regimen proved effective and safe in clinically stable IE patients. This approach offers advantages such as shorter hospital stays, enhanced quality of life and cost savings. Further data are needed to validate these findings and expand the use of oral regimens in broader clinical contexts.