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Cardio-oncology & otherRandomised controlled trial

Response-Tailored or Standard-Duration Antibiotic Treatment for Infective Endocarditis

N Engl J MedPublished

  • Randomised controlled trial
  • international
  • open-label
  • non-inferiority (primary safety end point)
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Authors' conclusion

Among patients with infective endocarditis on the left side of the heart, the use of a response-tailored antibiotic strategy resulted in a longer time alive without antibiotic therapy than standard-duration therapy and met the criterion for noninferiority with respect to safety but was associated with a higher incidence of relapse of bacteremia or infective endocarditis.

Study context

Population
Adults in stable condition with left-sided infective endocarditis caused by Staphylococcus aureus, Enterococcus faecalis or streptococcus species
Participants
508 adults
Comparison
Response-tailored vs standard-duration antibiotic therapy
Primary endpoint
Days alive without antibiotic treatment for infective endocarditis or bacteremia (superiority); primary safety: death from any cause, unplanned cardiac surgery or symptomatic embolic events (noninferiority, margin 7.5 percentage points)
Follow-up
6 months after randomization

Primary result

Days alive without antibiotic treatment · 6 months

Hodges-Lehmann estimated difference

13 days

95% CI 12–13

P < 0.001

By group

Tailored therapy vs Standard therapy
Hodges-Lehmann estimated difference 13 days (95% CI 12–13); P < 0.001

As reported in the abstract

Secondary outcomes

Relapse of bacteremia or infective endocarditis (key secondary)

P = 0.04

Safety

OutcomeTailored therapyStandard therapyabsolute between-group difference (percentage points) (95% CI)P value
Primary safety end point: death from any cause, unplanned cardiac surgery or symptomatic embolic events · 6 months · noninferiority8.2%10.7%−2.4 (−7.7 to 2.7)P < 0.001
  • Primary safety end point: death from any cause, unplanned cardiac surgery or symptomatic embolic events: noninferiority margin 7.5 percentage points; noninferiority met

Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.

Original publication

Response-Tailored or Standard-Duration Antibiotic Treatment for Infective Endocarditis. N Engl J Med. Published 28 August 2026. doi:10.1056/nejmoa2607887
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Summarised from the published abstract; every number is checked against it