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POET Trial Oral Switch in IE — EECC MCQ

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ModerateValvular Heart DiseasePOET Trial Oral Switch in IEEECC

A 72-year-old man with native aortic valve IE caused by viridans streptococcus responds well to IV antibiotics. After 3 weeks of IV therapy, he is clinically stable with negative blood cultures. The POET trial is discussed. What did it demonstrate?

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Correct answer: D — In selected stable patients with left-sided IE due to streptococci, staphylococci, or E. faecalis, partial oral switch after ≥10 days IV treatment is non-inferior to continued IV therapy

The POET (Partial Oral Treatment of Endocarditis) trial (2019) randomised stable patients with left-sided IE (streptococci, MSSA, coagulase-negative staphylococci, or E. faecalis) who had received ≥10 days IV treatment and met stability criteria (afebrile, declining CRP, no abscess/indication for surgery) to continue IV or switch to oral antibiotics. Oral switch was non-inferior for the composite of all-cause mortality, unplanned cardiac surgery, embolic events, or relapse. The 2023 ESC IE Guidelines incorporated this evidence, allowing partial oral switch in carefully selected patients (Class IIa) assessed by the endocarditis team. Oral regimens are high-dose and organism-specific. This does NOT apply to all IE — complex cases, prosthetic valve IE, and difficult-to-treat organisms require full IV courses.

Reference: ESC (2023): IE Guidelines; POET Trial