The addition of gentamicin for the first 3 to 5 days is an option and may accelerate the killing of the staphylococci, but this concept is based on extrapolation from experimental models. In patients without a history of type 1 penicillin allergic reac- tions, a first-generation cephalosporin, for example, cefazolin, is an alternative (for 4 6 weeks), with or without gentami- cin for the first 3 to 5 days.2,122 For patients unable to tolerate -lactam antibiotic drugs, vancomycin for a minimum of 6 weeks, with or without gentamicin for the first 3 to 5 days of therapy, is an alternative. Some staphylococcal strains may be methicillin resistant, and patients with IE caused by these organisms should not receive nafcillin, oxacillin, or a cephalosporin. Despite antibi- otic susceptibility results indicating that methicillin-resistant, coagulase-negative staphylococci are susceptible to cephalo- sporins, cross-resistance exists, and cephalosporins are not considered to be useful in these patients. Patients with meth- icillin-resistant staphylococcal endocarditis may be treated with vancomycin for a minimum of 6 weeks, with or without gentamicin for the first 3 to 5 days of therapy. It is the consen- sus of the writing group that patients with S aureus endocardi- tis should be cared for in a medical facility with cardiothoracic surgery capabilities and infectious diseases consultation. As with other IE cases, decisions about outpatient therapy may be individualized on the basis of clinical impression of symptom- atic recovery, cardiovascular stability, assessment of the fam- ily s ability to follow prescribed treatment, and availability of infrastructure for outpatient monitoring. Recommendations 1. 