Duke Criteria for Infective Endocarditis
Modified Duke Criteria stratify patients into definite, possible, or rejected infective endocarditis (IE) based on major and minor clinical and microbiological criteria
Score interpretation
Does not meet criteria for definite or possible IE. Alternative diagnosis likely or resolution with antibiotics ≤4 days.
→ Pursue alternative diagnoses. Consider ID review if clinical suspicion persists.
1 major + 1 minor, or 3 minor criteria met. Possible IE.
→ Admit. Serial blood cultures. Echocardiogram (TOE preferred). IV antibiotics empirically per local protocol. Cardiology/ID review.
2 major criteria, 1 major + 3 minor, or 5 minor criteria met. Definite IE.
→ Admit to cardiology/HDU. IV antibiotics (local microbiology guided). Urgent cardiology and ID input. Consider cardiac surgery referral for complicated IE.
Interpretation bands for the Duke Endocarditis. Apply clinical judgement and local guidance.
References
- Li JS, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30(4):633–638.
- Habib G, et al. 2015 ESC Guidelines for the management of infective endocarditis. Eur Heart J. 2015;36(44):3075–3128.
Related
Curated clinical cross-links plus same-class fallbacks.
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Featured in these MRCEM clinical pathways
The Duke Endocarditis is covered in detail — with RCEM/NICE evidence base, indications and pitfalls — in the following exam-focused pathways on our sister siteReviseMRCEM.
MRCEM Primary / Intermediate / OSCE candidates: each pathway includes exam-style questions, RCEM/NICE citations, and FAQ summaries.
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.