Patients with infections of the GI or GU tract may have intermittent or sustained enterococcal bacteremia. For patients with the conditions listed in Table 3 who have an established GI or GU tract infection or for those who receive antibiotic therapy to prevent wound infection or sepsis associated with a GI or GU tract procedure, it may be reasonable that the antibiotic regimen include an agent active against enterococci, such as penicillin, ampicillin, piperacillin, or vancomycin (Class IIb, LOE B); however, no published studies demonstrate that such therapy would prevent enterococcal IE. For patients with the conditions listed in Table 3 scheduled for an elective cystoscopy or other urinary tract manipulation who have an enterococcal urinary tract infection or coloniza- tion, antibiotic therapy to eradicate enterococci from the urine before the procedure may be reasonable (Class IIb, LOE B). If the urinary tract procedure is not elective, it may be reasonable that the empiric or specific antimicrobial regimen administered to the patient contain an agent active against enterococci (Class IIb, LOE B). Amoxicillin or ampicillin is the preferred agent for entero- coccal coverage for these patients. Vancomycin may be administered to patients unable to tolerate ampicillin. If infection is caused by a known or suspected strain of resistant enterococcus, consultation with an infectious diseases expert is recommended. Regimens for Procedures on Infected Skin, Skin Structure, or Musculoskeletal Tissue These infections are often polymicrobial, but only staphylococci and -hemolytic streptococci are likely to cause IE. 