**28. Treatment**

Recent studies demonstrate improved outcomes for patients with SPE with virtually all patients recovering from their illness. This may be attributable to earlier diagnosis, prompt administration of broad-spectrum antibiotics and improvements in surgical and supportive care. Discontinuation of vascular catheters/devices is recommended. In Lemierre's syndrome, vigorous antibiotic treatment for 4-6 weeks, targeting the organism and drainage of accessible abscesses are indicated. Internal jugular vein ligation/excision is rarely indicated as is the use of anticoagulation (Armstrong et al., 2000; Lustig et al., 1995). Consensus recommendation(American Heart Association (AHA), British Society for Antimicrobial Chemotherapy (BSAC), and the European Society for Cardiology (ESC)) is that, prompt use of antibiotics in treatment of endocarditis may result in reduction of incidence of SPE (Baddour et al., 2005; Elliott et al., 2004). The recommended duration of antibiotics is 4 to 6 weeks. The 2008 American College of Chest Physicians (ACCP) guidelines recommend against the use of routine antithrombotic therapy unless a separate indication exists.
