It was the consensus of the writing group that consultation with an infectious disease spe- cialist should be considered for all children with IE but espe- cially for IE caused by S pneumoniae that is not susceptible to penicillin. Recommendations 1. A 4-week regimen of intravenous aqueous crys- talline penicillin G (or ampicillin if penicillin G is unavailable) achieves a high cure rate in those with highly penicillin-susceptible streptococcal IE.112 This approach avoids aminoglycoside-containing regimens for children with impairment of renal function, concurrently administered nephrotoxic drugs, or eighth cranial nerve impairment. In adult patients, 4 weeks of therapy with ceftriaxone given once daily also is a recommended approach113 (Class I; Level of Evidence B). 2. Although home treatment for part of the antibiotic course appears to be becoming a more frequently used option, this decision is reasonable but requires careful selection of the appropriate candidate based on family accommodations and access to home healthcare providers (Class IIa; Level of Evidence B). species, or streptococci with an MIC of >0.5 g of penicillin per milliliter should be treated with the antibiotic regimen listed for enterococci (Class I; Level of Evidence C). For children who are unable to tolerate -lactam antibiotic drugs, vancomycin is an effective substitute, and current practice includes the addition of gentamicin for a 4-week course. 4. Obtaining blood concentrations of vancomycin and gentamicin, as well as renal function tests, weekly because of the possibility of nephrotoxicity with multiple nephrotoxic antibiotic drugs may be con- sidered (Class IIb; Level of Evidence C). 