POET-IIHot Line 1EndocarditisNew England Journal of Medicine
Response-Tailored Versus Standard-Duration Antibiotics for Infective Endocarditis
Response-Tailored or Standard-Duration Antibiotic Treatment for Infective Endocarditis
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Presenting authorHenning BundgaardHeart Failure / Cardiomyopathy · Rigshospitalet, Copenhagen, DenmarkHenning Bundgaard is Clinical Professor of Cardiology at the University of Copenhagen and senior consultant at the Department of Cardiology, Rigshospitalet. He is the author or co-author of publications including the 2023 ESC Guidelines for the management of cardiomyopathies and the POET trial on partial oral versus intravenous antibiotic treatment of endocarditis. His ORCID is 0000-0002-0563-7049.
HBHenning BundgaardMPMia Pries-HejeJHJulie Hjulmand
Overview
Supports response-tailored shorter antibiotics in left-sided IE with noninferior safety; extends RCT evidence but requires relapse monitoring.
Key result
Response-tailored antibiotic therapy for left-sided infective endocarditis increased median time alive without antibiotics by 13 days (95% CI 12-13; P<0.001 for superiority) compared to standard care.
Discussion
POET-II has reported — post the first read.
Expert takes
POET-II is a multicenter, open-label, non-inferiority randomized controlled trial evaluating whether tailored, shortened antibiotic treatment (2-4 weeks) for left-sided infective endocarditis is non-inferior to standard duration (4-6 weeks). Led by Henning Bundgaard from Rigshospitalet, the trial will be presented at ESC Congress 2026 Hot Line 1. The source material contains very limited expert commentary specifically about the POET-II trial — only general ESC Congress framing quotes are available, with no direct quotes from the trial investigators or independent commentators about the trial's findings.
Key Points
- Response-tailored antibiotic therapy significantly increased days alive without antibiotics compared to standard duration in left-sided infective endocarditis.
- A median of 183 days alive without antibiotics occurred with tailored care versus 169 days with standard care, but relapse rates were higher at 5.1% versus 1.6%.
- Randomized open-label trial across 508 patients demonstrated safety noninferiority, supporting shorter treatment while highlighting the necessity of relapse monitoring.
Study Design
Type
RCT (n=508)
Blinding
Open-label
Randomization
randomized
Multicenter
Yes
Structured PICO
Does a response-tailored antibiotic management strategy improve time alive without antibiotic treatment and maintain safety compared to standard-duration therapy in adults with left-sided infective endocarditis?
P
Population
508 adults in stable condition with infective endocarditis on the left side of the heart.
I
Intervention
Response-tailored antibiotic management strategy
C
Comparator
Standard-duration antibiotic therapy (up to 6 weeks)
O
Outcome
Time alive without antibiotic treatment and primary safety end-point eventsafety
A response-tailored antibiotic strategy for left-sided infective endocarditis increases time alive without antibiotics and is noninferior for safety, but carries a higher risk of relapse compared to standard 6-week therapy.
Main Result
Mean Difference: 13 (95% CI 12–13)
Absolute Event Rate: 183% vs 169%
p-value: p=<0.001 for superiority