OUTPATIENT TREATMENT OF ENDOCARDITIS IN A CLINIC-BASED PROGRAM IN ARGENTINA

The major cost in the treatment of infective endocarditis (IE) is the length of hospitalization required for the administration of intraveno us antibiotics. This can be reduced by substituting shorter regimens a nd by the introduction of outpatient parenteral antibiotic therapy (OP AT). Careful selection of patients is vital for the success of OPAT in IE. The patients should be hemodynamically stable and without clinica l complications. The delivery of OPAT for IE followed a clinical and h ome-based program involving an endocarditis team whose members include d an infectious diseases physician, a microbiologist, a cardiologist a nd a nurse trained in intravenous techniques. Among the antimicrobial agents used in OPAT of IE, single-agent ceftriaxone for four weeks fol lowed by a short course of amoxicillin or ceftriaxone in combination w ith 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, Cardiobacterium hominis, Eikenella corrodens and Kingella k ingae). Staphylococcus aureus, enterococci and late prosthetic valve e ndocarditis associated with a streptococcus may also be treated on an outpatient basis after stabilization (approximately 2 weeks). As a res ult of their need for prolonged treatment periods, these patients are also very good candidates for OPAT. In conclusion, new regimens utiliz ing ceftriaxone once daily and short-term therapy on a clinical or hom e basis offer the potential benefits of cheaper, safer and more conven ient treatment for patients with IE.