Recommended Antibiotic Treatments for Pediatric Infective Endocarditis* Organism/Condition Recommended Antibiotic Drug/Daily Antibiotic Dose Alternative Antibiotic Drug Choice Unknown agent (initial empirical therapy or culture-negative endocarditis, generally after at least 48 h of attempting to culture the causative organism except in severely ill children) Native valve (community acquired) or late prosthetic valve (>1 y after surgery) infection Ampicillin/sulbactam plus gentamicin Vancomycin (plus gentamicin) With or without vancomycin For prosthetic valve endocarditis, add rifampin IV divided every 4 6 h up to 12 g daily IV divided every 6 h up to 2 g IV divided every 8 h. IV divided every 8 divided every 12 h up to 600 mg IV every 6 h up to 2 g Nosocomial endocarditis associated with vascular cannulae or early prosthetic valve endocarditis ( 1 y after surgery) Vancomycin plus gentamicin ( rifampin if prosthetic material present) ? Plus cefepime or ceftazidime IV divided every 6 h up to 2 g IV divided every 8 h divided every 8 h up to 900 mg/d divided every 8 12 h up to 6 g/d IV divided every 8 h up to 2 4 g daily Streptococci Highly susceptible to penicillin G (MBC 0.1 g/mL); includes most viridans streptococci, groups A, B, C, G nonenterococcal, group D streptococci (S bovis, S equinus) Penicillin G or ceftriaxone IV divided every 4 h up to 12 24 million U daily IV divided every 12 h or IV every 24 h up to 4 g daily (if over 2 g, divide BID) Vancomycin or first-generation cephalosporin or ceftriaxone IV divided every 8 12 h up to 2 g daily IV divided every 8 h up to 12 g daily IV divided every 12 IV every 24 h up to 4 g daily Relatively resistant to penicillin (MBC 0.2 g/mL; includes enterococci and less-susceptible viridans streptococci) Penicillin G (or ampicillin) plus gentamicin (for first 2 wk, or whole course for enterococci) IV divided every 4 h up to 12 24 million U daily IV divided every 4 6 h up to 12 g daily IV divided every 8 h. Vancomycin plus gentamicin for enterococci Ampicillin plus ceftriaxone (for aminoglycoside- resistant enterococci or aminoglycoside- intolerant patient) Ceftriaxone plus gentamicin (not for enterococcal endocarditis) IV divided every 8 12 h up to 2 g daily IV divided every 8 IV divided every 12 IV every 24 h up to 4 g daily IV divided every 4 6 h up to 12 g daily Staphylococci (S aureus or coagulase-negative staphylococci) Susceptible to 1 g/mL penicillin G (rare) Penicillin G IV divided every 4 h up to 12 24 million U daily Oxacillin or nafcillin or first-generation cephalosporin or vancomycin Oxacillin or nafcillin 200 mg kg 1 IV divided every 4 6 h up to 12 g/d IV divided every 8 h up to 12 g daily IV divided every 8 12 h up to 2 g daily (Continued) Resistant to 0.1 g/mL penicillin G Penicillinase-resistant penicillin (oxacillin or nafcillin) gentamicin 3 5 d Vancomycin or a first-generation cephalosporin IV divided every 8 h up to 12 g daily IV divided every 8 12 h up to 2 g daily for those highly allergic to -lactam antibiotic drugs Oxacillin or nafcillin 200 mg kg 1 IV divided every 4 6 h up to 12 g/d IV divided every 8 h. Adults: 3 5 mg/kg Resistant to 4 g/mL oxacillin (MRSA) Vancomycin IV divided every 8 12 h up to 2 g daily Daptomycin for right-sided endocarditis, maybe for left-sided Daptomycin 6 mg/kg IV every 24 h; <6 y: 10 mg/kg Vancomycin resistant or intolerant Daptomycin ? 