Table 2 Antibiotic treatment for enterococcal, nutritionally‐variant and penicillin‐resistant (MIC >0.5 mg/l) streptococcal endocarditis.

Condition	No allergy to penicillin		Allergy to penicillin		Duration
	Drug	Dosage	Drug	Dosage
Enterococcal strain susceptible to penicillin, aminoglycosides, and vancomycin	Amoxicillin or	200 mg/kg/d	Vancomycin	30 mg/kg/d	4–6 weeks†
	penicillin G	300–400 000 U/kg/d	or teicoplanin	6–10 mg/kg/d
	+ gentamicin*	3 mg/kg/d	+ gentamicin*	3 mg/kg/d
Enterococcal strain susceptible to penicillin, streptomycin, vancomycin, and resistant to gentamicin	Amoxicillin or	200 mg/kg/d	Vancomycin	30 mg/kg/d	4–6 weeks†
	penicillin G	300–400 000 U/kg/d	or teicoplanin	6–10 mg/kg/d
	+ streptomycin‡	15 mg/kg/d	+ streptomycin‡	15 mg/kg/d
Enterococcal strain resistant to penicillin (intrinsic resistance), susceptible to gentamicin and vancomycin	Vancomycin	30 mg/kg/d	Vancomycin	30 mg/kg/d	6 weeks
	or teicoplanin	6–10 mg/kg/d	or teicoplanin	6–10 mg/kg/d
	+ gentamicin*	3 mg/kg/d	+ gentamicin*	3 mg/kg/d
Enterococcal strain resistant to penicillin (β–lactam producing), susceptible to gentamicin and vancomycin	Co‐amoxyclav	175 mg/kg/d amoxicillin	Vancomycin	30 mg/kg/d	6 weeks
	+ gentamicin*	3 mg/kg/d	or teicoplanin	6–10 mg/kg/d
			+ gentamicin*	3 mg/kg/d
Streptococcal and enterococcal strains with high‐level resistance to all aminoglycosides	Amoxicillin	>200 mg/kg/d	Vancomycin	30 mg/kg/d	⩾8 weeks
E faecalis resistant to penicillin, aminoglycosides and vancomycin	Amoxicillin	200 mg/kg/d	−	−	⩾8 weeks
	+ ceftriaxone or	2 g/d
	imipenem	2 g/d
E faecium resistant to penicillin, aminoglycosides and vancomycin	Linezolid, or	1200 mg/d	Linezolid, or	1200 mg/d	⩾8 weeks
	quinupristin‐dalfopristin	22.5 mg/kg/d	quinupristin‐dalfopristin	22.5 mg/kg/d

*Two or three daily doses.

†Duration of aminoglycoside administration could be shortened to 2–3 weeks; the total duration of treatment should be 6 weeks when vancomycin or teicoplanin are used.

‡Two daily doses.