Early consultation with infectious disease, car- diology, and cardiac surgery services is recommended for these patients. Amphotericin B has been the first-line antifungal agent for medical therapy, although it does not penetrate vegeta- tions well. Although the imidazoles (eg, fluconazole) do not have proven efficacy in human fungal IE, long-term suppressive therapy with these agents has been recom- mended by experts for patients with infections caused by susceptible organisms who are not able to undergo curative per day, divided every 6 hours) to amphotericin B given by mouth for Candida endocarditis caused by strains susceptible to 5-FC may provide additional benefit. Monitoring blood levels of 5-FC will minimize toxicity associated with this agent. The rationale is that the 2 drugs may act synergistically and potentiate fungal killing. The use of liposomal forms of amphotericin B is an alternative for patients with moderate to severe renal impairment or those with unacceptable infusion- related toxicities. In some centers, fluconazole or liposomal forms of amphotericin have been used successfully for native valve fungal endocarditis. Recommendations 1. For most patients with fungal IE, surgery in con- junction with antifungal agents is required. Early consultation with infectious disease, cardiology, and cardiac surgery services is recommended for these patients (Class I; Level of Evidence C). 2. The addition of 5-FC (100 150 mg/kg per day, divided every 6 hours) to amphotericin B given by mouth for Candida endocarditis caused by strains susceptible to 5-FC may be considered to provide additional benefit (Class IIb; Level of Evidence C). Monitoring of Antibiotic Blood Levels (for Children Beyond the Neonatal Period) When gentamicin is used for synergy, a reasonable dose is 3 to 6 mg/kg per day in children and is adjusted for a target peak blood concentration of 3 to 4 g/mL and a trough of <1 g/mL. 