The following criteria are essential for an effective OPAT program: A reliable support system at home and easy access to a hospital for prompt re-evaluation by an experienced clinician if a complication such as recurrence of fever, symptoms of a cardiac arrhythmia, heart failure, or a neurological event develops Regular visits by a home infusion nurse who carefully monitors the patient for early detection of complications, failure to respond to therapy, problems with adherence to therapy, or complications (eg, catheter-related infection, catheter leakage or displacement, venous thrombosis) directly related to the antibiotics or intravenous access Regular visits with an experienced clinician to assess clinical status during the OPAT Recommendations 1. Patients with IE should first be evaluated and sta- bilized in the hospital before being considered for outpatient therapy (Class I; Level of Evidence C). 2. Patients selected for OPAT should be at low risk for the complications of IE, the most frequent of which are heart failure and systemic emboli (Class I; Level of Evidence C). Care at Completion of Antimicrobial Therapy Short-Term Follow-Up The majority of patients with IE are cured with appro- priate medical and, if necessary, surgical treatment. Echocardiography is reasonable before or synchronous with completion of antimicrobial therapy to establish a new baseline for subsequent comparison (Table 18). A referral to a program to assist in the cessation of drug use should be made for IDUs. Patients should be educated about the signs of endocarditis and urged to seek immediate medical attention should they occur. If feasible, a thorough dental evaluation is reasonable, especially in patients deemed likely to require valve replace- ment, with all active sources of oral infection eradicated. All indwelling intravenous catheters used to infuse antimicrobial treatment should be removed promptly at the end of therapy. 