Medical Therapy Recommendations for Medical Therapy for IE Referenced studies that support the recommendations are summarized in Online Data Supplement 42. COR LOE Recommendations In patients with IE, appropriate antibiotic therapy should be initiated and continued after blood cultures are obtained, with guidance from antibiotic sensitivity data and the infectious disease experts on the MDT.1 7 Patients with suspected or confirmed IE associated with drug use should be referred to addiction treatment for opioid substitution therapy.8 10 In patients with IE and with evidence of cerebral embolism or stroke, regardless of the other indications for anticoagulation, it is reasonable to temporarily discontinue In patients with left-sided IE caused by streptococcus, Enterococcus faecalis, S. aureus, or coagulase-negative staphylococci deemed stable by the MDT after initial intravenous antibiotics, a change to oral antibiotic therapy may be considered if TEE before the switch to oral therapy shows no paravalvular infection, if frequent and appropriate follow-up can be assured by the care team, and if a follow-up TEE can be performed 1 to 3 days before the completion of the antibiotic course.25 In patients receiving VKA anticoagulation at the time of IE diagnosis, temporary discontinuation of VKA anticoagulation may 3: Harm C-LD Patients with known VHD should not receive antibiotics before blood cultures are obtained for unexplained fever.22,35,36 Synopsis Details of specific antimicrobial regimens have been published previously by the AHA, European Society of Cardiology, and British Society for Antimicrobial Che- motherapy and are not repeated in this guideline. In patients on anticoagulant therapy for AF or a mechani- cal heart valve, continued anticoagulation is associated with a higher risk of intracranial bleeding, particularly after an embolic event. In patients with suspected intravenous drug use, effective long-term therapy in- cludes referral to an addiction treatment program. 