Postoperative Antibiotic Management Duration Following Surgery for Intravenous Drug Abuse (IVDA) Endocarditis (OPTIMAL)

Inclusion Criteria:

• The age of the patient is ≥ 18.
• The patient has undergone an urgent or emergent primary cardiac valvar operation astreatment for IVDA endocarditis, with blood cultures positive for Streptococcus,Enterococcus faecalis, Staphylococcus aureus, or coagulase-negative Staphylococci
• The patient has received 2 weeks of postoperative inpatient IV antibiotic therapy withnegative blood cultures and no residual active infection by imaging (i.e. computerizedaxial tomography, echocardiography)
• The patient has the capacity to participate in a compliance tracking tool formedication administration (e.g. a centrally managed core site mobile Medisafecompliance https://www.medisafe.com/) as confirmed by both a physician and a caremanagement team member

Exclusion Criteria:

• Inability to give informed consent
• Residual infection requiring IV antibiotic therapy
• Any persistent secondary noncardiac infection (e.g. infections of solid organs orjoints)
• Known poor compliance or deemed incapable to comply with the compliance tracking tool
• Reduced absorption or inability to receive oral treatment due to a gastrointestinaldisorder
• Any infection involving a more virulent organisms, such as fungal infections orinfections with Serratia or HACEK infections (Haemophilus, Aggregatibacter,Cardiobacterium, Eikenella, Kingella).
• Cancer not otherwise in remission or in need of current or future oncologic therapy
• Medically immunocompromised state
• Reoperative valvar operation for IVDA endocarditis
• History of habitual noncompliance
• Pregnancy
• Mental incapacity
• Unable to perform local or institutional medical and psychiatric follow up
• Unstable home environment
• Inadequate access to mobile cell service (geographic/rurality)