First, these are the largest series of E faecalis IE reported to date, 43 patients in 1 study190 and 272 in the other Second, high-level aminoglycoside-resistant E faeca- lis IE treated with ampicillin-ceftriaxone therapy was present in 50% of the patients in the smaller study and 33% of patients in the larger study. Third, none of the patients in either study developed nephrotoxicity with ampicillin-ceftriaxone ther- patients developed nephrotoxicity (P<0.001). Fourth, in the larger study, the median age was 70 years in both treatment groups; however, patients in the ampicillin-ceftriaxone group were generally sicker and had more comorbid conditions (eg, chronic renal failure [P=0.004], neoplasm [P=0.015], and nosocomial acquisition of infection [P=0.006]). Fifth, in 1 study, PVE was present in 59 (37%) and 30 (34%) of patients treated with ampicillin-ceftriaxone and ampicillin- gentamicin, respectively, with similar success rates. Sixth, in the larger study, there were no significant differences between ampicillin-ceftriaxone and ampicillin-gentamicin in the need for surgery, complications (except for fewer cases of renal fail- ure in the ampicillin-ceftriaxone group), relapse, or mortality. Finally, the overall microbiological cure and success rates for ampicillin-ceftriaxone therapy in both studies were similar to rates in previously reported studies in patients treated with The major advantages of the ampicillin-ceftriaxone regi- men are the lower risk of nephrotoxicity and the lack of need for measuring aminoglycoside serum concentrations. The potential disadvantage is the possibility of hypersensitivity reactions to 2 separate -lactams. Because it would likely not be possible to discriminate between hypersensitivities related to ampicillin or to ceftriaxone, both drugs might have to be discontinued with substitution of vancomycin-gentamicin therapy. At this time, the writing group does not have a prefer- ence for one regimen over the other but rather advocates an individualized approach to regimen selection for each patient. Recommendations 1. 