A response-tailored strategy reduced antibiotic duration by two weeks without compromising the safety of patients with left-sided infective endocarditis.
This was the main finding from the POET-II trial, presented in a Hot Line session today at ESC Congress 2026 and published simultaneously in the New England Journal of Medicine.
In infective endocarditis, the heart's inner lining becomes infected, often alongside a bacterial infection in the bloodstream. Without antibiotics, infective endocarditis can be fatal.
Current management involves high-dose antibiotics for up to six weeks. The Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis (POET) I trial previously showed that patients with left-sided infective endocarditis can be safely switched from intravenous to oral antibiotics if they fulfill certain clinical, biochemical and imaging criteria, known as the POET criteria.
Seeking to further optimize antibiotic therapy, POET investigators turned their attention to individualizing the duration of antibiotics. Henning Bundgaard, principal investigator of the POET-II trial from Rigshospitalet—Copenhagen University Hospital, Denmark, explained, "Current recommendations of up to six weeks are based mostly on historical observations from the 1950s, when lower doses of antibiotic monotherapy were used. We hypothesized that tailoring antibiotic therapy in those who have an initial positive response could safely reduce the duration of antibiotics."
