Outpatient antibiotics improve the management of infective endocarditis associated with drug use

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March 02, 2022

2 minute read


Disclosures: Adams and Barocas do not report any relevant financial information. Please see the study for relevant financial information from all other authors.


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According to one study, outpatient antibiotics improved outcomes for patients with infective endocarditis associated with injection drug use compared to hospitalized patients.

According to Joella W. Adams, PhD, a researcher at Boston Medical Center and his colleagues.


Adams JW, et al.  JAMA Netw Open.  2022;doi:10.1001/jamanetworkopen.2022.0541.
Adams JW, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.0541.

“This increase has been widely associated with the opioid epidemic, particularly injection heroin and fentanyl,” they wrote in JAMA network open. “If current trends continue, more than 250,000 people in the United States could die from [injection drug use–associated infective endocarditis (IDU-IE)] between 2020 and 2030.

Adams and colleagues said there is a “substantial need” to define optimal treatment strategies, given the growing burden of IDU-IE in the United States.

To study the effectiveness of outpatient treatment of infective endocarditis, they created a model that simulates the natural history of injectable opioid use in 5 million people. According to the study, they compared life expectancies, treatment completion rates, endocarditis and overdose deaths, and average costs for four treatment strategies.

Two treatment strategies offered the standard 4 to 6 weeks of inpatient IV antibiotics, with or without inpatient drug abuse services. The other two provided 3 weeks of inpatient services of IV antibiotics and addiction care, followed by outpatient IV or oral antibiotics.

While the study demonstrated that the usual care strategy resulted in 18.63 years of life (YL) at a cost of $416,570 per person, with 77.6% of hospitalized patients completing treatment, it also showed that alternative strategies prolong life expectancy.

According to the researchers, the partial oral antibiotic therapy strategy yielded the highest treatment completion rate (80.3%) compared to the outpatient parenteral antibiotic therapy (OPAT) strategy (78.8%) and usual care/addiction care strategy (77.6%). The study data also showed that the OPAT strategy was the least expensive at $412,150 per person. Compared to the OPAT strategy, the partial oral antibiotic strategy had an incremental cost-effectiveness ratio of $163,370 per VA.

Based on the findings, the researchers suggested that the strategies could save the health care system more than $6 billion in hospitalizations for the approximately 750,000 Americans who inject drugs.

“Outpatient treatment approaches for endocarditis can not only save lives, but also save money that could then be allocated to evidence-based programs for the opioid crisis,” Joshua A. Barocas, MD, associate professor of medicine at the University of Colorado School of Medicine, said in a press release. “These strategies include promoting safer injections and other harm reduction techniques, improving access to medications for opioid use disorders, and funding outpatient support systems. “

He added: “It would allow people who use drugs to not only recover from endocarditis, but to do so in a way that they can more easily return to work, life and family.”

The references:

Home antibiotic treatments can improve health outcomes and reduce costs for patients with drug use-associated infective endocarditis. https://www.nih.gov/news-events/news-releases/take-home-antibiotic-therapies-may-improve-health-outcomes-lower-costs-patients-drug-use-associated-infective-endocarditis. Published February 28, 2022. Accessed March 1, 2022.

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