Oral antibiotic treatment of right-sided staphylococcal endocarditis in injection drug users

Prospective randomized comparison with parenteral therapy

Alan W. Heldman, Tina V. Hartert, Stuart C. Ray, Emile G. Daoud, Thomas E. Kowalski, Vincent J Pompili, Stephen D. Sisson, William C. Tidmore, Keith A. Vom Eigen, Steven N. Goodman, Paul S. Lietman, Brent G. Petty, Charles Flexner

Research output: Contribution to journalArticle

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Abstract

PURPOSE: To compare the efficacy and safety of inpatient oral antibiotic treatment (oral) versus standard parenteral antibiotic treatment (intravenous) for right-sided staphylococcal endocarditis in injection drug users. PATIENTS AND METHODS: In a prospective, randomized, non-blinded trial, febrile injection drug users were assigned to begin oral or intravenous (IV) treatment on admission, before blood culture results were available. Oral therapy consisted of ciprofloxacin and rifampin. Parenteral therapy was oxacillin or vancomycin, plus gentamicin for the first 5 days. Antibiotic dosing was adjusted for renal dysfunction. Administration of other antibacterial drugs was not permitted during the treatment or follow-up periods. Bacteremic subjects having right-sided staphylococcal endocarditis received 28 days of inpatient therapy with the assigned antibiotics. Test- of-cure blood cultures were obtained during inpatient observation 6 and 7 days after the completion of antibiotic therapy, and again at outpatient follow-up 1 month later. Criteria for treatment failure and for drug toxicity were prospectively defined. RESULTS: Of 573 injection drug users who were hospitalized because of a febrile illness and suspected right-sided staphylococcal endocarditis, 93 subjects (16.2%) had two or more sets of blood cultures positive for staphylococci; 85 of these bacteremic subjects (14.8%) satisfied diagnostic criteria for at least possible right-sided staphylococcal endocarditis (no other source of bacteremia was apparent) and entered the trial. Forty-four (oral, 19; IV, 25) of these 85 subjects completed inpatient treatment and evaluation including test-of-cure blood cultures. There were four treatment failures (oral, 1 [5.2%]; IV, 3 [12.0%]; not significant, Fisher's exact test). Drug toxicity was significantly more common in the parenterally treated group (oral, 3%; IV, 62%; P <0.0001), consisting largely of oxacillin-associated increases in liver enzymes. CONCLUSIONS: For selected patients with right-sided staphylococcal endocarditis, oral ciprofloxacin plus rifampin is effective and is associated with less drug toxicity than is intravenous therapy.

Original languageEnglish (US)
Pages (from-to)68-76
Number of pages9
JournalAmerican Journal of Medicine
Volume101
Issue number1
DOIs
StatePublished - Jan 1 1996

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Drug Users
Endocarditis
Anti-Bacterial Agents
Injections
Inpatients
Drug-Related Side Effects and Adverse Reactions
Therapeutics
Oxacillin
Rifampin
Ciprofloxacin
Treatment Failure
Fever
Patient Rights
Vancomycin
Bacteremia
Gentamicins
Staphylococcus
Outpatients
Observation
Kidney

ASJC Scopus subject areas

  • Medicine(all)

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Oral antibiotic treatment of right-sided staphylococcal endocarditis in injection drug users : Prospective randomized comparison with parenteral therapy. / Heldman, Alan W.; Hartert, Tina V.; Ray, Stuart C.; Daoud, Emile G.; Kowalski, Thomas E.; Pompili, Vincent J; Sisson, Stephen D.; Tidmore, William C.; Vom Eigen, Keith A.; Goodman, Steven N.; Lietman, Paul S.; Petty, Brent G.; Flexner, Charles.

In: American Journal of Medicine, Vol. 101, No. 1, 01.01.1996, p. 68-76.

Research output: Contribution to journalArticle

Heldman, AW, Hartert, TV, Ray, SC, Daoud, EG, Kowalski, TE, Pompili, VJ, Sisson, SD, Tidmore, WC, Vom Eigen, KA, Goodman, SN, Lietman, PS, Petty, BG & Flexner, C 1996, 'Oral antibiotic treatment of right-sided staphylococcal endocarditis in injection drug users: Prospective randomized comparison with parenteral therapy', American Journal of Medicine, vol. 101, no. 1, pp. 68-76. https://doi.org/10.1016/S0002-9343(96)00070-8
Heldman, Alan W. ; Hartert, Tina V. ; Ray, Stuart C. ; Daoud, Emile G. ; Kowalski, Thomas E. ; Pompili, Vincent J ; Sisson, Stephen D. ; Tidmore, William C. ; Vom Eigen, Keith A. ; Goodman, Steven N. ; Lietman, Paul S. ; Petty, Brent G. ; Flexner, Charles. / Oral antibiotic treatment of right-sided staphylococcal endocarditis in injection drug users : Prospective randomized comparison with parenteral therapy. In: American Journal of Medicine. 1996 ; Vol. 101, No. 1. pp. 68-76.
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T2 - Prospective randomized comparison with parenteral therapy

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AU - Ray, Stuart C.

AU - Daoud, Emile G.

AU - Kowalski, Thomas E.

AU - Pompili, Vincent J

AU - Sisson, Stephen D.

AU - Tidmore, William C.

AU - Vom Eigen, Keith A.

AU - Goodman, Steven N.

AU - Lietman, Paul S.

AU - Petty, Brent G.

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N2 - PURPOSE: To compare the efficacy and safety of inpatient oral antibiotic treatment (oral) versus standard parenteral antibiotic treatment (intravenous) for right-sided staphylococcal endocarditis in injection drug users. PATIENTS AND METHODS: In a prospective, randomized, non-blinded trial, febrile injection drug users were assigned to begin oral or intravenous (IV) treatment on admission, before blood culture results were available. Oral therapy consisted of ciprofloxacin and rifampin. Parenteral therapy was oxacillin or vancomycin, plus gentamicin for the first 5 days. Antibiotic dosing was adjusted for renal dysfunction. Administration of other antibacterial drugs was not permitted during the treatment or follow-up periods. Bacteremic subjects having right-sided staphylococcal endocarditis received 28 days of inpatient therapy with the assigned antibiotics. Test- of-cure blood cultures were obtained during inpatient observation 6 and 7 days after the completion of antibiotic therapy, and again at outpatient follow-up 1 month later. Criteria for treatment failure and for drug toxicity were prospectively defined. RESULTS: Of 573 injection drug users who were hospitalized because of a febrile illness and suspected right-sided staphylococcal endocarditis, 93 subjects (16.2%) had two or more sets of blood cultures positive for staphylococci; 85 of these bacteremic subjects (14.8%) satisfied diagnostic criteria for at least possible right-sided staphylococcal endocarditis (no other source of bacteremia was apparent) and entered the trial. Forty-four (oral, 19; IV, 25) of these 85 subjects completed inpatient treatment and evaluation including test-of-cure blood cultures. There were four treatment failures (oral, 1 [5.2%]; IV, 3 [12.0%]; not significant, Fisher's exact test). Drug toxicity was significantly more common in the parenterally treated group (oral, 3%; IV, 62%; P <0.0001), consisting largely of oxacillin-associated increases in liver enzymes. CONCLUSIONS: For selected patients with right-sided staphylococcal endocarditis, oral ciprofloxacin plus rifampin is effective and is associated with less drug toxicity than is intravenous therapy.

AB - PURPOSE: To compare the efficacy and safety of inpatient oral antibiotic treatment (oral) versus standard parenteral antibiotic treatment (intravenous) for right-sided staphylococcal endocarditis in injection drug users. PATIENTS AND METHODS: In a prospective, randomized, non-blinded trial, febrile injection drug users were assigned to begin oral or intravenous (IV) treatment on admission, before blood culture results were available. Oral therapy consisted of ciprofloxacin and rifampin. Parenteral therapy was oxacillin or vancomycin, plus gentamicin for the first 5 days. Antibiotic dosing was adjusted for renal dysfunction. Administration of other antibacterial drugs was not permitted during the treatment or follow-up periods. Bacteremic subjects having right-sided staphylococcal endocarditis received 28 days of inpatient therapy with the assigned antibiotics. Test- of-cure blood cultures were obtained during inpatient observation 6 and 7 days after the completion of antibiotic therapy, and again at outpatient follow-up 1 month later. Criteria for treatment failure and for drug toxicity were prospectively defined. RESULTS: Of 573 injection drug users who were hospitalized because of a febrile illness and suspected right-sided staphylococcal endocarditis, 93 subjects (16.2%) had two or more sets of blood cultures positive for staphylococci; 85 of these bacteremic subjects (14.8%) satisfied diagnostic criteria for at least possible right-sided staphylococcal endocarditis (no other source of bacteremia was apparent) and entered the trial. Forty-four (oral, 19; IV, 25) of these 85 subjects completed inpatient treatment and evaluation including test-of-cure blood cultures. There were four treatment failures (oral, 1 [5.2%]; IV, 3 [12.0%]; not significant, Fisher's exact test). Drug toxicity was significantly more common in the parenterally treated group (oral, 3%; IV, 62%; P <0.0001), consisting largely of oxacillin-associated increases in liver enzymes. CONCLUSIONS: For selected patients with right-sided staphylococcal endocarditis, oral ciprofloxacin plus rifampin is effective and is associated with less drug toxicity than is intravenous therapy.

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