Two week IV B-lactam regimen has previously been recommended but should ONLY be considered IF NONE OF BELOW APPLY:

  • metastatic infection or empyema
  • left side involved
  • prosthetic valve (urgent surgical consult required)
  • vegetations >2cm
  • lack of clinical or bacteriologic response at 96h
  • cardiac or extracardiac complications (e.g. ARF)
  • severe immunosuppression/CD4 < 200.

However most experts/guidelines favour longer duration with minimum of 2 weeks IV followed by oral antibiotics to complete 4-6 weeks [Circulation 2022;146:doi:10.1161/CIR.0000000000001090].