Cochrane Corner: A Comparison Of Antibiotic Regimens For The Treatment Of Infective Endocarditis

The actual burden of infective endocarditis (IE) is unknown.1 The scarcity of data from low-income countries is considered to be one reason for this,1 and heterogeneity in the design of other epidemiological studies is another. In 2020, IE continues to be a complex problem in medicine. The multiplicity of pathogens which cause IE, the increasing prevalence of intracardiac devices and the increasingly recognised need for surgery, as well as the different complications which can occur, explain why it is so difficult to choose an antibiotic regimen to treat any one patient with IE.2\n\nProper treatment of patients with IE requires a team made up of specialists in microbiology, infectious diseases, cardiology, including subspecialists with interest in imaging and cardiothoracic surgery.3 Finally, undoubtedly, there remain gaps in the evidence as to how best to manage IE.4 The basis of this Cochrane review was to assess the clinical benefits and harms of different antibiotic regimens to treat people with IE.5\n\nThe review by Marti-Carvajal et al is an update of a prior Cochrane review.5 The research question was ‘What are the clinical benefits and harms of the different antibiotic regimens used to treat people with IE?’ The updated search used the primary databases (the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase Classic and Embase, LILACS, CINAHL, and the Conference Proceedings Citation Index–Science) from 2016 until 6 January 2020. The randomised controlled trials (RCTs) included in this updated analysis assessed antibiotic regimens\u0027 effects to treat definite cases of IE diagnosed according to modified Duke criteria. The primary outcomes were all-cause mortality, cure rates and adverse events. People with possible IE and pregnant women were excluded. Trials with mixed populations were included, that is, trials where only a subset of participants met eligibility criteria. We …