Daily dental hygiene should be stressed, with serial evaluations by a dentist who is familiar with this patient population. Patients should be questioned about symptoms of heart failure, and a thorough physi- cal examination should be done. Additional evaluation with echocardiography is indicated in selected patients with posi- tive findings from history and physical examination. Patients should be instructed to seek immediate medical evaluation for persistent fever (Table 18). This is necessary because IE can mimic a variety of febrile illnesses. Blood cultures should be obtained. Antibiotic therapy should not be initiated for treat- ment of undefined febrile illnesses without blood cultures being obtained first. Antibiotics prescribed for nonspecific or unproved febrile syndromes are a major cause of (blood) culture-negative IE, and this practice should be strongly discouraged. Recommendations 1. Months to years after completion of medical ther- apy for IE, patients should have ongoing observa- tion for and education about recurrent infection and delayed onset of worsening valve dysfunction (Class I; Level of Evidence C). 2. Daily dental hygiene should be stressed, with serial evaluations by a dentist who is familiar with this patient population (Class I; Level of Evidence C). 3. Patients should be questioned about symptoms of heart failure, and a thorough physical examination should be done (Class I; Level of Evidence C). 4. Additional evaluations with echocardiography should be obtained in selected patients with posi- tive findings from history and physical examina- tion (Class I; Level of Evidence C). 5. Patients should be instructed to seek immediate medical evaluation for fever, and blood cultures should be obtained (Class I; Level of Evidence C). 6. Antimicrobial therapy should not be initiated for the treatment of undefined febrile illnesses unless the patient s condition (eg, sepsis) warrants it (Class III; Level of Evidence C). 