The Lancet has featured a review article looking at the strengths and limitations of present therapeutic strategies for infective endocarditis and proposing future directions for better management according to the most recent research.  The following areas are discussed:

• Evolution of treatment and mortality

- Antimicrobial therapy: benefits and limits

- Early valve surgery

• Challenges and perspectives

- Challenges in diagnostic strategies: perspectives in microbiological testing

- Challenges in diagnostic strategies: perspectives in imaging investigations

- Challenges in prognostic assessment

- Challenges in treatment

- Close long-term follow-up

The authors note that despite improvements in medical and surgical therapies, infective endocarditis is associated with poor prognosis and remains a therapeutic challenge. Novel perspectives on the management of endocarditis are emerging and offer hope for decreasing the rate of residual deaths by accelerating the process of diagnosis and risk stratification, reducing delays in starting antimicrobial therapy, rapid transfer of high-risk patients to specialised medico-surgical centres, development of new surgical methods, and close long-term follow-up.