Response-Tailored or Standard-Duration Antibiotic Treatment for Infective Endocarditis.

Response-tailored antibiotic therapy for infective endocarditis on the left side of the heart results in 13 more days alive without antibiotics within 6 months compared to standard therapy.

• Why it matters: Determining whether shorter, response-based treatment can safely replace longer, standardized courses could optimize patient outcomes and reduce antibiotic exposure, addressing a gap in evidence-based guidelines.
• What they did: In an international, randomized trial, 508 adults with infective endocarditis caused by S. aureus, E. faecalis, or streptococcus species, all stabilized after 2-4 weeks of therapy, were assigned to response-tailored or standard-duration antibiotic regimens, with primary endpoints assessing days alive without antibiotics and safety within 6 months.
• The result: Response-tailored therapy was noninferior in safety (8.2% vs. 10.7% adverse events) and increased days alive without antibiotics, but it was associated with a higher relapse rate (5.1% vs. 1.6%), suggesting it may extend antibiotic-free periods at the potential cost of increased relapse.