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JAC Advance Access originally published online on September 19, 2007
Journal of Antimicrobial Chemotherapy 2007 60(5):921-928; doi:10.1093/jac/dkm324
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© The Author 2007. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Systematic reviews

Antimicrobials for right-sided endocarditis in intravenous drug users: a systematic review

Derek Yung1, Dan Kottachchi1, Binod Neupane2, Shariq Haider1 and Mark Loeb2,*

1 Department of Medicine, McMaster University, Hamilton, Ontario, Canada 2 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada

Received 4 June 2007; returned 27 June 2007; revised 30 July 2007; accepted 1 August 2007

* Corresponding author. Tel: +1-905-525-9140 ext. 26066; Fax: +1-905-389-5822; E-mail: loebm{at}mcmaster.ca

Background: Right-sided endocarditis (RSE) is a serious complication of intravenous drug use. We sought to systematically review the evidence for obtaining clinical cure with antimicrobials in intravenous drug users (IVDUs) with isolated native valve RSE.

Search strategy: We applied broad search strategies in the following databases: MEDLINE (1966–2006), EMBASE (1980–2006) and Cochrane CENTRAL Register (2006, Issue 3). Hand searching was performed on selected peer-reviewed journals and relevant citation lists were screened. No restrictions were set on language and type of publication.

Selection criteria: We included randomized controlled trials that evaluated clinical and microbiological cure using single or combination antibiotic regimens for the treatment of isolated native valve bacterial RSE. Clinical and microbiological cure and failure outcomes were evaluated between 2 weeks and 6 months after completion of therapy. Quality assessment of relevant studies was performed using an objective scoring scale.

Results: We identified seven randomized controlled trials, one comparing single antimicrobial therapies, four comparing combination with single therapy and two studies comparing combination therapies. Short-course therapy was present in at least one arm in three studies, but only one study compared short- and long-course therapy. No statistically significant benefit was demonstrated between any antimicrobial therapy and all studies were scored as having a moderate to severe risk of bias.

Conclusions: Randomized trial evidence does not support one antimicrobial regimen over another in the treatment of RSE in IVDUs.

Keywords: antibiotics , treatment , IVDUs


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