Outpatient treatment of endocarditis in a clinic-based program in Argentina

Abstract

The major cost in the treatment of infective endocarditis (IE) is the length of hospitalization required for the administration of intravenous antibiotics. This can be reduced by substituting shorter regimens and by the introduction of outpatient parenteral antibiotic therapy (OPAT). Careful selection of patients is vital for the success of OPAT in IE. The patients should be hemodynamically stable and without clinical complications. The delivery of OPAT for IE followed a clinical and home-based program involving an endocarditis team whose members included an infectious diseases physician, a microbiologist, a cardiologist and a nurse trained in intravenous techniques. Among the antimicrobial agents used in OPAT of IE, single-agent ceftriaxone for four weeks followed by a short course of amoxicillin or ceftriaxone in combination with an aminoglycoside for two weeks (short course) are effective modes of treatment for streptococcal endocarditis, the most common cause of IE. This treatment is also effective for carefully selected patients with other types of endocarditis, such as those due to the HACEK group (Haemophilus aphrophilus/paraphrophilis, Actinobacillus actinomycetem comitans, Caradiobacterium hominis, Eikenella corrodens and Kingella kingae). Staphylococcus aureus, enterococci and late prosthetic valve endocarditis associated with a streptococcus may also be treated on an outpatient basis after stabilization (approximately 2 weeks). As a result of their need for prolonged treatment periods, these patients are also very good candidates for OPAT. In conclusion, new regimens utilizing ceftriaxone once daily and short-term therapy on a clinical or home basis offer the potential benefits of cheaper safer and more convenient treatment for patients with IE.