Abstract
Because of unique host defense characteristics of the endocardium, successful therapy for infective endocarditis (IE) has necessitated bactericidal antimicrobial agents, generally administered in high doses for prolonged periods of time. This has required therapy in the hospital setting. However, in recent years, it has become apparent that outpatient therapy is feasible if appropriate agents can be administered at home, for example, using either home parenteral therapy or oral preparations. Over the past few decades, there has been a trend toward reducing inpatient reimbursement for various conditions, including serious infections. The decision to treat IE on an outpatient basis is made more easily if based on previous published experience. Published reports have concluded that outpatient therapy is more appropriate for “uncomplicated” IE caused by relatively susceptible microorganisms. The purpose of this paper is to review data describing the results of management of IE in the outpatient setting.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References and Recommended Reading
Durack DT, Lukes AS, Bright DK, and the Duke endocarditis service: New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Am J Med 1995, 96:200–209.
Francioli P, Ruch W, Stamboulian D: Treatment of streptococcal endocarditis with a single daily dose of ceftriaxone and netilmicin for 14 days: a prospective multicenter study. Clin Infect Dis 1995, 21:1406–1410.
Graninger W, Presterl E, Wenisch C, et al.: Management of serious staphylococcal infections in the outpatient setting. Drugs 1997, 54:21–28.
Sexton DJ, Tenenbaum MJ, Wilson NR, et al., and the Endocarditis Treatment Consortium Group: Ceftriaxone once daily for four weeks compared with ceftraixone plus gentamicin once daily for two weeks for treatment of endocarditis due to penicillin susceptible streptococci. Clin Infect Dis 1998, 27:1470–1474. This well-designed study re-established that 4 weeks of ceftriaxone monotherapy and 2 weeks of combined therapy with ceftriaxone and gentamicin were equally efficacious in treating penicillinsusceptible streptococcal IE. These drugs have come to be widely used in outpatient antibiotic therapy.
Huminer D, Bishara J, Pitlik S: Home intravenous antibiotic treatment for patients with infective endocarditis. Eur J Clin Microbiol Infect Dis 1999, 18:330–334. These authors published their experience with a variety of pathogens causing IE, and had favorable results. Their success may be partly due to closer supervision enabled by the unique social setting of a number of their patients.
Stamboulian D, Bonhevi P, Arevalo C, et al.: Antibiotic management of outpatients with endocarditis due to penicillin susceptible streptococci. Rev Infect Dis 1991, 13(suppl 2):S160-S163.
Stamboulian D: Outpatient treatment of endocarditis in a clinic based program in Argentina. Eur J Clin Microbiol Infect Dis 1995, 14:648–669.
von Reyn CF, Levy BS, Arbeit RD, et al.: Infective endocarditis: an analysis based on strict case definitions. Ann Intern Med 1981, 94:505–518.
Francioli P, Etienne J, Hoigne R, et al.: Treatment of streptococcal endocarditis with a single daily dose of ceftriaxone sodium for four weeks. JAMA 1992, 267:264–267.
Harris LF, Buckle TF, Coffey FL: Intravenous antibiotics at home. South Med J 1986, 79:193–196.
Williams DN, Gibson JA, Bosch D: Home intravenous antibiotic therapy using a programmable infusion pump. Arch Intern Med 1989, 149:1157–1160.
Green SL: Practical guidelines for developing an office based program for outpatient intravenous therapy. Rev Infect Dis 1991, 13:S189-S192.
Colford JM, Corelli RL, Ganz JW, Guglielmo BJ: Home antibiotic therapy for streptococcal endocarditis: a call for a controlled trial. Am J Med 1993, 94:111–112.
Grayson M, Silvers J, Turnidge J: Home intravenous antibiotic therapy: a safe and effective alternative to inpatient care. Med J Aust 1995, 162:249–253.
Wiselka MJ, Nicholson KG: Outpatient parenteral antimicrobial therapy: experience in a large teaching hospital. J Infect 1997, 35:73–76. A review of outpatient treatment of various infections, which explores the diseases and the characteristics of patients best suited for outpatient therapy, the antibiotics commonly used in such settings, and the issues of cost effectiveness and acceptability of such therapy to patients.
Russo TA, Cook S, Gorbach SL: Intramuscular ceftriaxone in home parenteral therapy. Antimicrob Agents Chemother 1988, 32:1439–1444.
Richardson JV, Karp RB, Kirklin JW, et al.: Treatment of infective endocarditis: a 10 year comparative analysis. Circulation 1978, 58:589.
Karchmer AW, Dismukes WE, Buckley MJ, et al.: Late prosthetic valve endocarditis: clinical features influencing therapy. Am J Med 1978, 64:199.
DiNubile MJ: Short course antibiotic therapy for right sided endocarditis caused by S. aureus in injection drug users. Ann Intern Med 1994, 121:873–876.
Heldman AW, Hartert TV, Ray SC, et al.: Oral antibiotic treatment of right sided staphylococcal endocarditis in injection drug users: prospective randomized comparison with parenteral therapy. Am J Med 1996, 101:68–76.
Jessurun C, Mesa A, Wilansky S: Utility of transesophageal echocardiography in infective endocarditis-a review. Texas Heart Instit J 1996, 23:98–107.
Sanfilippo AJ, Picard MH, Newell JB, et al.: Echocardiographic assessment of patients with infectious endocarditis. J Am Coll Cardiol 1991, 18:1191.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Monteiro, CA., Cobbs, C.G. Outpatient management of infective endocarditis. Curr Infect Dis Rep 3, 319–327 (2001). https://doi.org/10.1007/s11908-001-0068-6
Issue Date:
DOI: https://doi.org/10.1007/s11908-001-0068-6