– Amoxicillin (or ampicillin) 200 mg/kg/d IV in 4-6 divided doses for 4-6 weeksa + gentamicinb 3 mg/kg/d IV or IM as single dose for 2-6 weeks; or

 – Ampicillin 200 mg/kg/d IV in 4-6 divided doses for 6 weeks + ceftriaxone 4 g/d IV or IM in 2 divided doses for 6 weeksc; or

 – Vancomycin 30 mg/kg/d in 2 divided doses for 6 weeks + gentamicinb 3 mg/kg/d IV as single dose for 6 weeks

Enterococci with high levels of aminoglycoside resistance

Ampicillin or amoxicillin + ceftriaxone for 6 weeks

Vancomycin-resistant enterococci

Daptomycin 10-12 mg/kg/d combined with one of: ampicillin (300 mg/kg/d), ertapenem (2 g/d in single dose), ceftaroline (1800 mg/d in 3 doses), or fosfomycin (12 g/d in 4 doses) for 6 weeks

Multidrug-resistant strains (resistance to aminoglycosides, beta-lactams, and vancomycin)d

 – Daptomycin 10 mg/kg/d combined with one of: ampicillin 200 mg/kg/d IV in 4-6 doses for ≥8 weeks; ertapenem (2 g/d IV), ceftaroline (600 mg tid IV), or fosfomycin (3 g IV qid); or

 – Linezolid 600 mg IV or PO bid for ≥8 weeks; or

 – Quinupristin/dalfopristin 7.5 mg/kg tid for ≥8 weeks

Third-generation cephalosporin (eg, ceftriaxone 2 g/d for 4 weeks in NVE or 6 weeks in PVE); non–beta-lactamase-producing strains: ampicillin 12 g/d IV in 4 or 6 divided doses combined with gentamicin 3 mg/kg/d in 2 or 3 divided doses for 4-6 weeks

Doxycycline 200 mg/d + trimethoprim/sulfamethoxazole 960 mg bid + rifampin 300-600 mg/d for ≥3-6 months PO; in the first few weeks you may add streptomycin 15 mg/kg/d in 2 divided doses

Doxycycline 200 mg/d + hydroxychloroquine 200-600 mg/d PO (this is preferred over doxycycline alone) for >18 months

Doxycycline 100 mg PO bid for 4 weeks + gentamicin 3 mg/kg/d IV for 2 weeks

Levofloxacin 500 mg IV or PO bid for ≥6 weeks or clarithromycin 500 mg bid IV for 2 weeks, then PO for 4 weeks + rifampin 300-1200 mg for 6 weeks

Levofloxacin 500 mg IV or PO bid for ≥6 months

Doxycycline 200 mg/d + hydroxychloroquined 200-600 mg/d PO (this is preferred over doxycycline alone) for ≥18 months

a Treatment lasting 6 weeks is recommended in patients with symptoms persisting for >3 months and in those with a prosthetic valve. 2015 AHA guidelines allow aqueous penicillin G 18-30 million units/d in place of ampicillin.

c Regimen recommended in Enterococcus faecalis infection. It is the treatment of choice for aminoglycoside-resistant E faecalis species. Ineffective for Enterococcus faecium.

d Cooperation with an infectious disease specialist is essential.