According to findings from the POET-II study presented at ESC Congress 2026 and simultaneously published in NEJM, a clinical response-tailored antibiotic strategy shortened antibiotic duration by two weeks compared with standard therapy in patients with left-sided infective endocarditis, showing non-inferiority for safety and an increase in days alive without treatment.
POET-II Study Results: Tailored Antibiotic Duration for Endocarditis
Researchers running the POET-II trial randomized approximately 500 patients to either response-tailored therapy or standard-duration antibiotic therapy. According to the study data, all participants received a minimum of two to four weeks of therapy and met criteria for clinical stabilization before randomization took place. Following randomization, patients assigned to the tailored-therapy cohort discontinued antibiotics. Meanwhile, those in the standard therapy arm continued their treatment regimen for four to six weeks.
Primary efficacy results showed that the median time alive without antibiotic treatment reached 183 days with tailored therapy. This compares against 169 days for patients receiving standard therapy, according to trial data presented at ESC Congress 2026.
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Safety and Relapse Data in Tailored Endocarditis Therapy
Primary safety endpoints evaluated a composite of death from any cause, unplanned cardiac surgery, or symptomatic embolic events within six months after randomization. According to the findings, a primary safety endpoint event occurred in 21 patients, representing 8.2% of the tailored therapy group. This compared with 27 patients, or 10.7%, in the standard therapy group, indicating non-inferiority for the shortened approach.
However, researchers tracked a higher number of bacteremia or infective endocarditis relapses in the shortened treatment arm. Relapse events occurred in 13 patients in the tailored therapy group, compared with 4 patients in the standard therapy group. Study investigators noted that most of these relapse events were managed through the reinitiation of antibiotics.
Potential Impact on Clinical Practice and Patient Quality of Life
Henning Bundgaard, MD, DMSc, the study’s principal investigator from Rigshospitalet – Copenhagen University Hospital, Denmark, stated that the landmark trial has the potential to change clinical practice.
“We estimate that around half of the patients that we see in our clinics with left-sided infective endocarditis could be eligible for tailored reduced-duration antibiotic therapy,” said Henning Bundgaard, MD, DMSc. “Shorter courses of antibiotics may also improve patients’ quality of life by reducing the physical and psychological toll associated with prolonged antibiotic treatment and hospitalisations.”
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Frequently Asked Questions
What was the primary efficacy endpoint of the POET-II study?
The primary efficacy endpoint measured days alive without antibiotic treatment for infective endocarditis or bacteremia within six months after randomization.
How many patients participated in the POET-II trial?
Researchers randomized approximately 500 patients to either the response-tailored therapy group or the standard-duration antibiotic therapy group.
Did the tailored therapy group show more relapses?
Yes, researchers noted that relapse events occurred in 13 patients in the tailored therapy group compared with 4 patients in the standard therapy group, though most were managed by reinitiating antibiotics.
Who led the POET-II study?
The study was led by principal investigator Henning Bundgaard, MD, DMSc, from Rigshospitalet – Copenhagen University Hospital, Denmark.
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