Data on effectiveness of antibiotic drugs for IE in children generally come from reviews of experience. Because these are nonexperimental, there is a lack of useful informa- tion to compare different antibiotic regimens head-to-head; therefore, these and other recommendations in the literature are based on preferred practice in adults, qualitative interpre- tation of outcomes from pediatric reviews, and expert opinion from this committee. Recommendations 1. In patients who are not severely ill (do not have respiratory or hemodynamic compromise or change in mental status) and whose blood cultures remain negative or whose cultures may be positive for organisms that are frequently contaminants, it is reasonable to withhold antibiotic drugs for 48 hours while additional blood cultures are obtained (Class IIa; Level of Evidence C). 2. A prolonged course of therapy (at least 4 weeks and often 6 8 weeks; Table 6) has been the recom- mended practice (Class I; Level of Evidence B). 3. Bactericidal rather than bacteriostatic antibiotic drugs should be chosen whenever possible (Class I; Level of Evidence A). This recommendation is based on past reports of treatment failures and relapses when only bacteriostatic antibiotic drugs were given. 4. In infants and children, one should use intravenous antibiotic drugs rather than intramuscular agents. The patients small muscle mass is one reason (Class I; Level of Evidence C). Outpatient (home) intrave- nous treatment of endocarditis may be considered in selected patients after initial treatment in the hos- pital and confirmation that these patients are hemo- dynamically stable and afebrile, have negative blood cultures, and are not at high risk for complications (ie, not of young age and do not have a fungal patho- gen) (Class IIb; Level of Evidence C). 5. Patient and parent adherence to the medical plan is important. 