The most common reasons for surgical management of IE are congestive heart failure, progressive valve dysfunction, and embolic phenomena. Prediction of an individual patient s risk for embolization Documented Bartonella, initially culture negative, determined to be positive by nonculture tests Doxycycline 200 mg/d IV or PO in 2 equally divided doses 6 IIa/B If gentamicin cannot be given, then replace it with rifampin 600 mg/d PO/IV in 2 equally divided doses plus IV/IM in 3 equally divided doses Pediatric dosage: Ceftriaxone 100 mg kg 1 IV/IM once daily; gentamicin 3 mg kg 1 IV/ IM in 3 equally divided doses; doxycycline 2 4 IV/PO in 2 equally divided doses; PO/IV in 2 equally divided doses As discussed in the text, these recommendations are based on consensus of experts and not experimental comparative studies (Class IIa; Level of Evidence C). Note: Pediatric dosage should not exceed that of a normal adult. IM indicates intramuscular; IV, intravenous; LOE, level of evidence; and PO, oral. *Dosages recommended are for patients with normal renal function. If ampicillin-sulbactam is unavailable, vancomycin is the suggested alternative (see Table 7 for empirical treatment of native valve infective endocarditis). See text and Table 7 for appropriate dosing of gentamicin. See Table 7 for appropriate dosing of vancomycin. Table 8. 