Patients should be aware that relapses can occur and that new onset of fever, chills, or other evidence of systemic toxicity mandates immediate evalu- ation, including a thorough history and physical examination and 3 sets of blood cultures (Class I; Level of Evidence C). 10. Because of concerns for IE relapse, a thorough evalua- tion should be done to determine the cause of infection signs and symptoms (Class I; Level of Evidence C). 11. Empirical antimicrobial therapy for suspected infection should be avoided unless the patient s clinical condition (eg, sepsis) warrants it (Class III; Level of Evidence C). 12. It is reasonable to have patients who have completed therapy and do not have symptoms of systemic tox- icity undergo an examination after completing anti- biotic therapy (Class IIa; Level of Evidence C). 13. Developing or worsening heart failure is a common complication that should be monitored for during short-term follow-up (Class I; Level of Evidence C). 14. If heart failure develops or worsens, the patient should be evaluated immediately for cardiac sur- gery (Class I; Level of Evidence B). 15. Antibiotic toxicity still can occur after the comple- tion of treatment and is a complication that should be considered during short-term follow-up (Class I; Level of Evidence C). 16. No tools are routinely available for monitoring vestibular function, and patients should be told to report the onset of any symptoms of vestibular toxicity during or after treatment (Class I; Level of Evidence C). Long-Term Follow-Up Months to years after completion of medical therapy for IE, patients should have ongoing observation for and education about recurrent infection and delayed onset of worsening valve dysfunction (Table 18). Daily dental hygiene should be stressed, with serial evaluations by a dentist who is familiar with this patient population. 