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Paediatric antibiotic dosage and route Penicillin G 200 000 U/kg/day i.v. in 4–6 divided doses Amoxicillin 200–300 mg/kg/day i.v. in 4–6 doses, up to maximum of 12 g/day Ceftriaxone 100 mg/kg i.v. in 1 dose Gentamicind 3 mg/kg/day i.v. or i.m. in 1 dose or 3 equally divided dosesd Allergy to beta-lactams In patients allergic to beta-lactams and with IE due to oral streptococci and S. gallolyticus, vancomycin for 4 weeks in NVE or for 6 weeks in PVE is recommended using the following doses:292 I C Adult antibiotic dosage and route Vancomycine 30 mg/kg/day i.v. in 2 dosese Paediatric antibiotic dosage and route Vancomycine 30 mg/kg/day i.v. in 2 or 3 equally divided dosese Oral streptococci and Streptococcus gallolyticus group susceptible, increased exposure or resistant to penicillin In patients with NVE due to oral streptococci and S. gallolyticus, penicillin G, amoxicillin, or ceftriaxone for 4 weeks in combination with gentamicin for 2 weeks is recommended using the following doses:285–290 I B Adult antibiotic dosage and route Penicillin G 24 million U/day i.v. either in 4–6 doses or continuously Amoxicillin 12 g/day i.v. in 4–6 doses Ceftriaxone 2 g/day i.v. in 1 dose Gentamicin 3 mg/kg/day i.v. or i.m. in 1 dosed In patients with PVE due to oral streptococci and S. gallolyticus, penicillin G, amoxicillin, or ceftriaxone for 6 weeks combined with gentamicin for 2 weeks is recommended using the following doses:285–290

I B

Adult antibiotic dosage and route Penicillin G 24 million U/day i.v. either in 4–6 doses or continuously Amoxicillin 12 g/day i.v. in 4–6 doses Ceftriaxone 2 g/day i.v. in 1 dose Gentamicind 3 mg/kg/day i.v. or i.m. in 1 dosed Allergy to beta-lactams In patients with NVE due to oral streptococci and S. gallolyticus and who are allergic to beta-lactams, vancomycin for 4 weeks is recommended using the following doses: I C Adult antibiotic dosage and route Vancomycine 30 mg/kg/day i.v. in 2 dosese Paediatric antibiotic dosage and route Vancomycine 30 mg/kg/day i.v. in 2 dosese In patients with PVE due to oral streptococci and S. gallolyticus and who are allergic to beta-lactams, vancomycin for 6 weeks combined with gentamicin for 2 weeks is recommended using the following doses:

I C

Adult antibiotic dosage and route Vancomycine 30 mg/kg/day i.v. in 2 dosese Gentamicind 3 mg/kg/day i.v. or i.m. in 1 dosed Paediatric antibiotic dosage and route Vancomycine 30 mg/kg/day i.v. in 2 dosese Gentamicind 3 mg/kg/day i.v. or i.m. in 1 dosed © ESC 2023

IE, infective endocarditis; i.m., intramuscular; i.v., intravenous; NVE, native valve endocarditis; PVE, prosthetic valve endocarditis; U, units. aClass of recommendation. bLevel of evidence. cThe starting recommended doses are the lower doses which can be scalable to the highest doses. dMaximum doses 240 mg/day. High doses are associated with increased risk of nephrotoxicity. Renal function and serum gentamicin concentrations should be monitored once a week. When given in a single daily dose, pre-dose (trough) concentrations should be <1 mg/L and post-dose (peak; 1 h after injection) serum concentrations should be ∼10–12 mg/L. eSerum vancomycin concentrations should achieve 10–15 mg/L at pre-dose (trough) level, although some experts recommend to increase the dose of vancomycin to 45–60 mg/kg/day i.v. in 2 or 3 divided doses to reach serum trough vancomycin levels (Cmin) of 15–20 mg/L as in staphylococcal endocarditis. However, vancomycin dose should not exceed 2 g/day unless serum levels are monitored and can be adjusted to obtain a peak plasma concentration of 30–45 μg/mL 1 h after completion of the i.v. infusion of the antibiotic. Downloaded from academic.oup.com/eurheartj/article/44/39/3948/7243107 by guest on 07 October 2026