RecentRCT

POET II

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

New England Journal of Medicine, 2026 · International open-label randomized superiority and noninferiority trial, 508 patients

Population: Selected clinically stable adults with left-sided S. aureus, E. faecalis or streptococcal endocarditis after at least 2–4 weeks of therapy
Intervention: Response-tailored antibiotic discontinuation after stability criteria
Comparator: Standard total antibiotic duration 4–6 weeks
Primary outcome: Days alive without antibiotic treatment at six months and composite safety noninferiority
Result: Tailored therapy increased antibiotic-free time and met composite safety noninferiority, but relapse was 5.1% versus 1.6% (P=.04).

What the trial found

Tailored therapy increased antibiotic-free time and met composite safety noninferiority, but relapse was 5.1% versus 1.6% (P=.04).

Current guideline position

This trial must be interpreted alongside indication-specific guidance; its result alone does not establish a universal treatment policy.

Clinical interpretation

Discuss shorter therapy only with an endocarditis team in the trial-defined stable population; relapse risk prevents a blanket recommendation.

Limitations

Not evidence for unstable ICU endocarditis.
The safety composite did not include relapse; the noninferiority margin was 7.5 percentage points.

Clinical Context & Relevant Topics (1)

Disease Reference

Critical AS, acute AR/MR mechanics, prosthetic valve emergencies, and infective endocarditis with multidisciplinary surgical triggers.