Skip to content
How It Works
Explore
Resources Ask a Question
Who It's For
Patients
Decode results, prep for appointments, weigh options.
Caregivers & advocates
Carry the research load for someone you love.
Providers & clinicians
Resources for patients in your practice.
Log In Ask a Question
PubMed This is a summary of 21 peer-reviewed journal articles Updated
Cardiology

Treatment: From Long-Term Antibiotics to Life-Saving Surgery

At a Glance

Treating infective endocarditis requires 4 to 6 weeks of intensive antibiotics to clear the infection. Many patients can safely switch from IV to oral pills during recovery. Nearly half of all patients will also need heart surgery to repair damaged valves or remove large bacterial growths.

Treating infective endocarditis (IE) is an intensive process that often requires a combination of long-term medications and, in many cases, specialized surgery. The goal of treatment is to completely clear the infection from the heart valve and prevent it from spreading to the rest of the body [1][2].

The Antibiotic Marathon

Because the bacteria in an endocarditis “vegetation” are shielded by a protective layer of clot and protein, they are very difficult to kill. This is why treatment lasts for weeks rather than days:

  • Native Valve IE: If the infection is on your natural heart valve, you will typically receive intravenous (IV) antibiotics for 4 to 6 weeks [3].
  • Prosthetic Valve IE: If you have an artificial valve or a heart device, the treatment is even more intensive, usually lasting at least 6 weeks [4][5]. This longer course is necessary because bacteria can “hide” more easily on artificial materials [6].

A Shift in Strategy: The POET Trial

For a long time, doctors believed the entire treatment course had to be done via IV in a hospital. However, a landmark study called the POET trial changed this thinking for certain patients. The trial found that patients with stable left-sided endocarditis could safely switch to oral antibiotics (pills) to finish their treatment [7][8].

  • Requirements: To be eligible for this “step-down” to oral pills, you must first be clinically stable (no fever or complications) and have already completed at least 10 days of IV therapy [9][10].
  • Benefits: Switching to oral medications can shorten your hospital stay, reduce the risk of infections from IV lines, and improve your overall quality of life during recovery [7][11].

When Surgery is the Safest Path

Nearly half of all patients with endocarditis will eventually need surgery [12]. While heart surgery is a major undertaking, for many patients it is actually the safest option because it physically removes the source of the infection and repairs the heart before permanent damage occurs [13][14]. There are three main reasons your Endocarditis Team might recommend surgery:

  1. Heart Failure: This is the most common reason for surgery. If the infection has damaged a valve so much that it can no longer pump blood effectively, surgery is often needed urgently to restore heart function [15][16].
  2. Uncontrolled Infection: If the bacteria are not responding to antibiotics—leading to persistent fevers or the formation of an abscess (a pocket of pus) inside the heart—surgery is necessary to “clean out” the infection [17][18].
  3. Preventing Embolism: If an ultrasound (TEE) shows a large vegetation (typically larger than 10 mm), there is a high risk that a piece of it could break off and cause a stroke. Surgeons may operate early just to remove that risk [19][20].

Choosing the right time for surgery is a delicate balance. Your team will use specialized tools to weigh the risks of surgery against the risks of continuing with antibiotics alone, ensuring you receive the most protective care possible [12][21].

Common questions in this guide

How long does treatment for infective endocarditis take?
Treatment usually lasts for 4 to 6 weeks if the infection is on your natural heart valve. If you have an artificial valve or heart device, you will typically need at least 6 weeks of intensive antibiotics to fully clear the bacteria.
Can I take pills instead of IV antibiotics for endocarditis?
Yes, some patients can safely switch from intravenous antibiotics to oral pills once they are stable. To qualify, you must have no fever, have completed at least 10 days of IV therapy, and have approval from your care team.
Why would I need surgery for infective endocarditis?
Nearly half of all patients require surgery to physically remove the infection and repair the heart. Your doctor may recommend surgery if the infection causes heart failure, creates a pocket of pus, or forms a large growth that could cause a stroke.
What is a vegetation in endocarditis and why is it dangerous?
A vegetation is a cluster of bacteria shielded by a protective layer of clot and protein on your heart valve. If a large vegetation breaks off, it can travel through your bloodstream and cause life-threatening complications like a stroke.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Based on the POET trial, am I a candidate to switch from IV to oral antibiotics at some point during my recovery?
  2. 2.What are the specific milestones I need to hit (like no fever or clear blood cultures) to be considered 'clinically stable'?
  3. 3.Does the size of my heart valve vegetation put me at a high risk for a stroke or other embolic events?
  4. 4.Is my infection affecting the heart's ability to pump, and are there signs of heart failure that would make surgery necessary?
  5. 5.If I need surgery, will it be to repair the valve or replace it entirely?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (21)
  1. 1

    Prospective Clinical Follow-Up Results of Infective Endocarditis.

    Arslan M, Kaleli İ, Kutlu M

    Infectious diseases & clinical microbiology 2024; (6(2)):133-140 doi:10.36519/idcm.2024.327.

    PMID: 39005701
  2. 2

    Endocarditis in Patients with Aortic Valve Prosthesis: Comparison between Surgical and Transcatheter Prosthesis.

    De Palo M, Scicchitano P, Malvindi PG, Paparella D

    Antibiotics (Basel, Switzerland) 2021; (10(1)) doi:10.3390/antibiotics10010050.

    PMID: 33419074
  3. 3

    Clinicomicrobiological spectrum of infective endocarditis - from a tertiary care centre in south India.

    Padmaja K, Sudhaharan S, Vemu L, et al.

    Iranian journal of microbiology 2017; (9(5)):257-263.

    PMID: 29296269
  4. 4

    An Aminoglycoside-Sparing Regimen with Double Beta-Lactam to Successfully Treat Granulicatella adiacens Prosthetic Aortic Valve Endocarditis-Time to Change Paradigm?

    Pagotto A, Campanile F, Conti P, et al.

    Infectious disease reports 2024; (16(2)):249-259 doi:10.3390/idr16020020.

    PMID: 38525767
  5. 5

    Prosthetic-Valve Endocarditis with Discordant Isolates: A Case Report and a Review of the Literature.

    Ferri R, Mucedola F, Conserva M, et al.

    Infectious disease reports 2026; (18(1)) doi:10.3390/idr18010017.

    PMID: 41718071
  6. 6

    Aortic Root Replacement for Destructive Endocarditis - Clinic and Microbiology.

    Szczechowicz MP, Weymann A, Mkalaluh S, et al.

    Brazilian journal of cardiovascular surgery 2021; (36(5)):614-622 doi:10.21470/1678-9741-2020-0412.

    PMID: 34236800
  7. 7

    Endocarditis: oral versus intravenous antibiotics.

    Le Bras A

    Nature reviews. Cardiology 2018; (15(11)):653 doi:10.1038/s41569-018-0095-8.

    PMID: 30237427
  8. 8

    Long-Term Outcomes of Partial Oral Treatment of Endocarditis.

    Bundgaard H, Ihlemann N, Gill SU, et al.

    The New England journal of medicine 2019; (380(14)):1373-1374 doi:10.1056/NEJMc1902096.

    PMID: 30883059
  9. 9

    [Should infective endocarditis be treated with oral antibiotics?]

    Sigaloff KCE

    Nederlands tijdschrift voor geneeskunde 2019; (163()).

    PMID: 31050269
  10. 10

    Clinical implementation of partial oral treatment in infective endocarditis: the Danish POETry study.

    Pries-Heje MM, Hjulmand JG, Lenz IT, et al.

    European heart journal 2023; (44(48)):5095-5106 doi:10.1093/eurheartj/ehad715.

    PMID: 37879115
  11. 11

    Length of Hospital Stay for Endocarditis Before and After the Partial Oral Treatment of Endocarditis Trial.

    Østergaard L, Pries-Heje MM, Voldstedlund M, et al.

    Journal of the American College of Cardiology 2024; (84(23)):2293-2304 doi:10.1016/j.jacc.2024.06.053.

    PMID: 39603750
  12. 12

    Conservative Versus Surgical Therapy in Patients With Infective Endocarditis and Surgical Indication-Meta-Analysis of Reconstructed Time-to-Event Data.

    Caldonazo T, Hagel S, Doenst T, et al.

    Journal of the American Heart Association 2024; (13(7)):e033404 doi:10.1161/JAHA.123.033404.

    PMID: 38533941
  13. 13

    Multivariate and survival analysis of prognosis and surgical benefits in infective endocarditis.

    Song TX, Sun YD, Zhang B, et al.

    Scandinavian cardiovascular journal : SCJ 2025; (59(1)):2429994 doi:10.1080/14017431.2024.2429994.

    PMID: 39718350
  14. 14

    Could Early Surgery Get Beneficial in Adult Patients with Active Native Infective Endocarditis? A Meta-Analysis.

    Jia L, Wang Z, Fu Q, et al.

    BioMed research international 2017; (2017()):3459468 doi:10.1155/2017/3459468.

    PMID: 28326318
  15. 15

    Infective endocarditis: innovations in the management of an old disease.

    Iung B, Duval X

    Nature reviews. Cardiology 2019; (16(10)):623-635 doi:10.1038/s41569-019-0215-0.

    PMID: 31175343
  16. 16

    "To Fix a Broken Heart": An Unusual Case of Infective Endocarditis Involving the Mitral Valve With Perforation and Hemodynamic Instability.

    Munshi R, Pellegrini JR, Tsiyer AR, et al.

    Cureus 2021; (13(9)):e18367 doi:10.7759/cureus.18367.

    PMID: 34725616
  17. 17

    The diagnostic ability of echocardiography for infective endocarditis and its associated complications.

    Vilacosta I, Olmos C, de Agustín A, et al.

    Expert review of cardiovascular therapy 2015; (13(11)):1225-36 doi:10.1586/14779072.2015.1096780.

    PMID: 26471429
  18. 18

    Corynebacterium jeikeium-induced infective endocarditis and perivalvular abscess diagnosed by 16S ribosomal RNA sequence analysis: A case report.

    Imoto W, Takahashi Y, Yamada K, et al.

    Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 2021; (27(6)):906-910 doi:10.1016/j.jiac.2021.01.005.

    PMID: 33549416
  19. 19

    Determinants and consequences of positive valve culture when cardiac surgery is performed during the acute phase of infective endocarditis.

    Fillâtre P, Gacouin A, Revest M, et al.

    European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology 2020; (39(4)):629-635 doi:10.1007/s10096-019-03764-z.

    PMID: 31773364
  20. 20

    Risk of embolic events before and after antibiotic treatment initiation among patients with left-side infective endocarditis.

    Papadimitriou-Olivgeris M, Guery B, Ianculescu N, et al.

    Infection 2024; (52(1)):117-128 doi:10.1007/s15010-023-02066-z.

    PMID: 37402113
  21. 21

    A predictive model for early mortality after surgical treatment of heart valve or prosthesis infective endocarditis. The EndoSCORE.

    Di Mauro M, Dato GMA, Barili F, et al.

    International journal of cardiology 2017; (241()):97-102 doi:10.1016/j.ijcard.2017.03.148.

    PMID: 28390740

This page explains infective endocarditis treatment options for educational purposes. Your cardiologist and infectious disease team are the best sources for your specific care plan.

Get notified when new evidence is published on Infective endocarditis.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.