ReviewJAMA internal medicine2020
Evaluation of a Paradigm Shift From Intravenous Antibiotics to Oral Step-Down Therapy for the Treatment of Infective Endocarditis: A Narrative Review.
Review in JAMA internal medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 40 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Partial Oral Antimicrobial Versus Intravenous Antimicrobial Therapy to Treat Infective Endocarditis in People Who Inject Drugs
Postoperative Antibiotic Management Duration Following Surgery for Intravenous Drug Abuse (IVDA) Endocarditis (OPTIMAL)
Who cites it
40 citing papers in PubMed, 1 synthesis or guideline pooled it, 80 citations in OpenAlex.
- Oral Is the New IV. Challenging Decades of Blood and Bone Infection Dogma: A Systematic Review.The American journal of medicine · 2022Pooled it
- Partial Oral Antibiotic Therapy for Infective Endocarditis: A Practical Review of Current Evidence and Guidelines.Pathogens (Basel, Switzerland) · 2026Review
- Combination antibiotic therapy in Staphylococcus aureus endocarditis: evidence, controversies, and future directions.Infection · 2026Review
- Should We Extend the Use of Oral Antibiotics in Infective Endocarditis? The ENDO-ORAL Study.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Article
- Novel use of oral delafloxacin monotherapy in staphylococcal prosthetic valve endocarditis: A case report.Infectious medicine · 2026Article
- Characterizing the Use of High-Dose Amoxicillin for the Treatment of Bacteremia.Pathogens (Basel, Switzerland) · 2026Article
- Efficacy and Safety of Contezolid as Salvage Treatment for Gram-Positive Bacterial Infections: A Retrospective Multicenter Study.Infection and drug resistance · 2026Article
- The impact of a best practice advisory for shifting to oral medications: A quality improvement project.Journal of hospital medicine · 2025Article
- Reply to Datta, "Is static or cidal antibiotic falsifiable?"Antimicrobial agents and chemotherapy · 2025Article
- Legends, dogmas, presumptions, and demystifications in antibiotic therapy.Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2025Review
- Cellulosimicrobium cellulans endocarditis: a challenge for detection and treatment in interdisciplinary teams.Infection · 2025Article
- Health Economic Analysis of an All-Virtual, At-Home Acute Care Model.JAMA network open · 2025Article
- Physician awareness of fluid volume administered with intravenous antibiotics: a structured interview-based study.Clinical and experimental emergency medicine · 2025Article
- Association Between Inpatient Medication Treatment for Opioid Use Disorder and Reduced One-Year All-Cause Mortality in Patients With Invasive Bacterial Infections.Open forum infectious diseases · 2025Article
- A Precision Medicine Model for Targeted Antibiotic Therapy in Urinary Tract Infections: A Valuable Tool to Reduce Hospitalization Stay and the Time to Switch to Oral Treatment.Antibiotics (Basel, Switzerland) · 2025Article
- Diagnostic Impact of FISHseq as a New Pathologic Criterion for Endocarditis According to the Duke Criteria.Open forum infectious diseases · 2025Article
- Assessment of IV-to-PO conversion guideline implementation in pediatric cancer and bone marrow transplant patients after line removal for bloodstream infection.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2025Article
- Breaking the Dogma of Intravenous Treatment for Infective Endocarditis: A Systematic Review and Meta-Analysis.Journal of clinical medicine · 2024Review
- Endocarditis Therapy: The Move From Expert Opinion to Evidence.Journal of the American College of Cardiology · 2024Article
- Prolonged outpatient parenteral antimicrobial treatment: frequency and evolution over a six-year period in a Swiss University Hospital.BMC infectious diseases · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 5 institutions in 1 country.
Funding
Abstract
Importance: The requirement of prolonged intravenous antibiotic courses to treat infective endocarditis (IE) is a time-honored dogma of medicine. However, numerous antibiotics are now available that achieve adequate levels in the blood after oral administration to kill bacteria. Moreover, prolonged intravenous antibiotic regimens are associated with high rates of adverse events. Accordingly, recent studies of oral step-down antibiotic treatment have stimulated a reevaluation of the need for intravenous-only therapy for IE. Observations: PubMed was reviewed in October 2019, with an update in February 2020, to determine whether evidence supports the notion that oral step-down antibiotic therapy for IE is associated with inferior outcomes compared with intravenous-only therapy. The search identified 21 observational studies evaluating the effectiveness of oral antibiotics for treating IE, typically after an initial course of intravenous therapy; none found such oral step-down therapy to be inferior to intravenous-only therapy. Multiple studies described an improved clinical cure rate and an improved mortality rate among patients treated with oral step-down vs intravenous-only antibiotic therapy. Three randomized clinical trials also demonstrated that oral step-down antibiotic therapy is at least as effective as intravenous-only therapy in right-sided, left-sided, or prosthetic valve IE. In the largest trial, at 3.5 years of follow-up, patients randomized to receive oral step-down antibiotic therapy had a significantly improved cure rate and mortality rate compared with those who received intravenous-only therapy. Conclusions and Relevance: This review found ample data demonstrating the therapeutic effectiveness of oral step-down vs intravenous-only antibiotic therapy for IE, and no contrary data were identified. The use of highly orally bioavailable antibiotics as step-down therapy for IE, after clearing bacteremia and achieving clinical stability with intravenous regimens, should be incorporated into clinical practice.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.