The first is delayed ototoxicity because of the previous use of aminoglycosides. Audiological and Table 18. Care During and After Completion of Antimicrobial Treatment Initiation before or at completion of therapy Echocardiography to establish new baseline Drug rehabilitation referral for patients who use illicit injection drugs Education on the signs of endocarditis and need for antibiotic prophylaxis for certain dental/surgical/invasive procedures Thorough dental evaluation and treatment if not performed earlier in evaluation Prompt removal of intravenous catheter at completion of antimicrobial therapy Short-term follow-up At least 3 sets of blood cultures from separate sites for any febrile illness and before initiation of antibiotic therapy Physical examination for evidence of heart failure Evaluation for toxicity resulting from current/previous antimicrobial therapy Long-term follow-up At least 3 sets of blood cultures from separate sites for any febrile illness and before initiation of antibiotic therapy Evaluation of valvular and ventricular function (echocardiography) Scrupulous oral hygiene and frequent dental professional office visits Baddour et al Infective Endocarditis in Adults 1473 vestibular toxicity can develop despite the maintenance of appropriate serum drug concentrations during treatment. For patients receiving long-term aminoglycosides, particu- larly those with underlying renal or otic disorders, serial audiograms may be considered during therapy if feasible and available. No tools are routinely available for monitor- ing vestibular function, and patients should be told to report the onset of any symptoms of vestibular toxicity during or after treatment. The second antibiotic-related adverse event is Clostridium difficile infection. Onset of diarrhea can be delayed as long as 4 weeks after the last dose of antibiotic. The hope is that prompt recognition and treatment of this infectious complica- tion will diminish the likelihood of severe complications. Recommendations 1. 