Table 1.

Therapeutic options for the treatment of Enterococcus faecalis infective endocarditis

Agent (s)	Comments
PENb or AMPa,b plus an aminoglycoside (GEN or SM)c	• 4–6 weeks for the treatment of E. faecalis without HLR to aminoglycosides [9].
	• Shorter duration of the aminoglycoside (2 weeks) may be considered in selected patients in order to decrease toxicity [11, 12].
AMP plus CROd	• Recommended for E. faecalis exhibiting HLR to aminoglycosides [9].
	• May be considered as first choice for E. faecalis without HLR to aminoglycosides, especially in patients at high risk of renal toxicity [14•].
VAN plus AGc	• To be considered for patients with severe allergy to β-lactams who cannot be desensitized.
DAPe±AMPb or CPT	• Combinations may have a synergistic effect and may also prevent emergence of DAP resistance during therapy [21, 23].
DAPe plus GEN	• Could be considered in cases of β-lactam allergy.

PEN penicillin, AMP ampicillin, GEN gentamicin, SM streptomycin, HLR high-level resistance, CRO ceftriaxone, ampicillin/sulbactam, VAN vancomycin, DAP daptomycin, CPT ceftaroline

^aFor rare case of β-lactamase-producing E. faecalis, ampicillin/sulbactam12 g IV q24 h in four equally divided doses can be used, instead of AMP

^bPEN: 18–30 million U q24 h IV by continuous infusion or in six equally divided doses; AMP, 12–20 g q24 h IV in six equally divided doses

^cGEN is more often used due to the availability of serum level tests. GEN dose is 3 mg/kg per day IV in three equally divided doses

^dA CRO dose of 2 g q12 h should be used

^eConsider DAP doses of 8–12 mg/kg IV daily