If the isolate is resistant (MIC 2 g/mL) to cefo- taxime, then the addition of vancomycin and rifampin may be considered. Ceftriaxone may be considered instead of cefotaxime in the previous recommendations. These find- ings are based on current levels of resistance, and increasing MICs could dictate revisions in future treatment selections. Accordingly, the treatment of patients with pneumococcal IE should be coordinated in consultation with an infectious diseases specialist. For S pyogenes IE, penicillin G administered intrave- nously for 4 to 6 weeks is reasonable treatment on the basis of limited published data. Ceftriaxone is a reasonable alternative to penicillin. Vancomycin is reasonable only for patients who are unable to tolerate a -lactam antibiotic. In general, strains of group B, C, F, and G streptococci are slightly more resistant to penicillin than are strains of group A streptococci. In these patients, the addition of gentamicin to penicillin or to ceftriaxone for at least the first 2 weeks of a 4- to 6-week course of antimicrobial therapy for group B, C, and G streptococcal IE may be considered.132,133 There is a clini- that early cardiac surgical intervention has improved overall survival rates among treated patients with -hemolytic streptococcal IE compared with patients treated decades ago. Because of the relative infrequency of IE caused by these microorganisms, consultation with an infectious dis- eases specialist during treatment is recommended. Recommendations 1. Four weeks of antimicrobial therapy with penicillin, cefazolin, or ceftriaxone is reasonable for IE caused by S pneumoniae; vancomycin can be useful for patients intolerant of -lactam therapy (Class IIa; Level of Evidence C). 2. Six weeks of therapy is reasonable for PVE caused by S pneumoniae (Class IIa; Level of Evidence C). 3. 