Role of Aminoglycosides in the Treatment of Patients With Enterococcal IE: Special Considerations Aminoglycoside-containing regimens have been a cornerstone of antimicrobial therapy for enterococcal IE187 and have been recommended as standard therapy in previous (1995) AHA Since the publication of the latest (2005) AHA statement on antimicrobial therapy of patients with IE,12 the frequency of aminoglycoside-resistant strains of enterococci has increased significantly. In addition, a number of studies have been published on the dosing of aminoglycosides, the duration of aminoglycoside therapy, and the possible role of non aminoglycoside-containing regimens for the treatment of E faecalis IE.189 191 Approximately 97% of cases of enterococcal IE are caused by E faecalis, and the majority of these remain susceptible to -lactams and vancomycin, but aminoglycoside resistance is increasing in frequency. In the study by Gavald et al,190 approximately half of the patients had IE caused by high- level aminoglycoside-resistant strains of E faecalis. In the study by Fern ndez-Hidalgo et al,191 26% of the 272 patients had high-level aminoglycoside-resistant strains of E faecalis. Therefore, aminoglycoside-containing regimens would not be effective therapy for these patients. A number of factors should be considered in the selec- tion of aminoglycoside-containing regimens. Compared with other patients with IE, in general, patients with enterococcal IE are older; are often debilitated; may have complicated, underlying urological conditions, including pre-existing renal failure; may have healthcare-associated infections; and have significant other underlying comorbidities common in older In these patients, gentamicin-associated neph- rotoxicity may significantly complicate a standard 4- to 6-week course of therapy and could result in serious, possibly life-threatening, complications such as renal failure requiring hemodialysis. 