Endocarditis: oral antibiotics

Oral Antibiotics Safe Stable Endocarditis

Switching after a period of IV antibiotics didn't raise event rates in POET trial

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• by Crystal Phend, Senior Associate Editor, MedPage TodayAugust 28, 2018
• This article is a collaboration between MedPage Today® and:
   

MUNICH -- Switching to oral antibiotics once an endocarditis patient is stable appears safe and could allow them to head home from the hospital sooner, the randomized Partial Oral Treatment of Endocarditis (POET) trial showed.

The group getting oral tablets after at least 10 days IV antibiotics had a 9.0% rate of all-cause mortality, unplanned cardiac surgery, embolic events, or relapse of bacteremia with the primary pathogen by 6 months after completion of treatment.

That rate was noninferior to the 12.1% in the IV-only antibiotic group (HR 0.72, P=0.40), Henning Bundgaard, MD, of Rigshospitalet in Copenhagen, reported here at the European Society of Cardiology meeting and simultaneously online in the New England Journal of Medicine.

Bacteremia Associated With Toothbrushing and Dental Extraction

Peter B. Lockhart, DDS; Michael T. Brennan, DDS, MHS; Howell C. Sasser, PhD; Philip C. Fox, DDS; Bruce J. Paster, PhD; Farah K. Bahrani-Mougeot, PhD (Circulation. 2008;117:3118-3125.)© 2008 American Heart Association, Inc.
Background— Antibiotic prophylaxis recommendations for the prevention of infective endocarditis are based in part on studies of bacteremia from dental procedures, but toothbrushing may pose a greater threat. The purpose of this study was to compare the incidence, duration, nature, and magnitude of endocarditis-related bacteremia from single-tooth extraction and toothbrushing and to determine the impact of amoxicillin prophylaxis on single-tooth extraction.
Methods and Results— In this double-blind, placebo-controlled study, 290 subjects were randomized to (1) toothbrushing, (2) single-tooth extraction with amoxicillin prophylaxis, or (3) single-tooth extraction with identical placebo. Blood was drawn for bacterial culturing and identification at 6 time points before, during, and after these interventions. The focus of our analysis was on bacterial species reported to cause infective endocarditis. We identified 98 bacterial species, 32 of which are reported to cause endocarditis. Cumulative incidence of endocarditis-related bacteria from all 6 blood draws was 23%, 33%, and 60% for the toothbrushing, extraction-amoxicillin, and extraction-placebo groups, respectively (P<0.0001). Significant differences were identified among the 3 groups at draws 2, 3, 4, and 5 (all P<0.05). Amoxicillin resulted in a significant decrease in positive cultures (P<0.0001).
Conclusions— Although amoxicillin has a significant impact on bacteremia resulting from a single-tooth extraction, given the greater frequency for oral hygiene, toothbrushing may be a greater threat for individuals at risk for infective endocarditis.