Work

Generalizability of Oral Therapy for Staphylococcus aureus Bacteremia or Endocarditis: Don’t Cook the Goose

Year: 2024

Type: article

Abstract: To the Editor—We thank Dr Lee and colleagues for their thought-provoking letter [1] in response to our systematic review and meta-analysis, where we concluded that transitioning to oral antibiotics may be as effective as intravenous therapy for select patients with Staphylococcus. aureus bacteremia or endocarditis [2]. However, we emphasized the limited generalizability of these findings, as have other studies [3], and the need for additional randomized trials to determine when oral therapy can be routinely recommended. Although Lee and colleagues provide valuable insights on the historical underutilization of oral antibiotic therapy, they may have oversimplified considerations for serious S. aureus infections. In addition to oral bioavailability of antibiotics, factors such as antibiotic adherence, drug interactions, adverse effects, comorbid medical conditions, and social determinants of health may also play a critical role in treatment outcomes. These factors often differ between clinical trial participants and the population of patients seen in clinical practice. For example, the POET trial excluded people who used injection drugs and utilized frequent outpatient follow-up visits, laboratory monitoring, and therapeutic drug monitoring of oral antibiotics, all of which may not reflect the typical setting for clinical care [4]. We agree that oral therapy is reasonable for patients meeting certain clinical criteria, but we caution against equating it with the current standard of care based on the available evidence. Before recommending widespread use of oral therapy, it is essential to understand its risks and benefits in broader populations. Given the significant morbidity and mortality of these infections, it is crucial not to rush into recommending oral therapy without sufficient evidence—and risk cooking the goose. Author Contributions. Drafting of the manuscript: A. M., T. C. J. Critical review of the manuscript for important intellectual content: A. M., T. L. H., T. C. J. Supervision: T. L. H., T. C. J. Acknowledgments. None Role of the sponsor. N/A Financial support. None

Source: Clinical Infectious Diseases

DOI: 10.1093/cid/ciae566

Authors: Ahmad Mourad, Thomas L Holland, Timothy C Jenkins