Version July 2025
| American Heart Association (AHA) | European Society of Cardiology (ESC) | |
| Adult | Pediatric | Adult |
| One of the following: Ceftriaxone¶ 2 g per 24 hours IV in 1 dose for 4 weeksΔ or Ampicillin◊ 2 g IV every 4 hours for 4 weeksΔ or Ciprofloxacin§ 1000 mg per 24 hours orally in 2 divided doses or 800 mg per 24 hours IV in 2 divided doses for 4 weeksΔ | Monotherapy: Ceftriaxone¶ 100 mg/kg per 24 hours IV in 2 divided doses, or 80 mg/kg in 1 daily dose (maximum dose: 4 g per 24 hours; if dose is >2 g per 24 hours, use divided dosing every 12 hours) for 4 weeksΔ or Cefotaxime 200 mg/kg per 24 hours IV in 4 divided doses (maximum dose: 12 g per 24 hours) for 4 weeksΔ | One of the following: Ceftriaxone¶ 2 g per 24 hours IV in 1 dose for 4 weeksΔ or Combination therapy with: Ampicillin◊ 12 g per 24 hours IV in 6 divided doses for 4 weeks plus Gentamicin¥ 3 mg/kg per 24 hours IV or IM in 2 or 3 divided doses for the initial 2 weeksΔ or Ciprofloxacin§ 750 mg every 12 hours orally or 400 mg every 8 or 12 hours IV for 4 weeksΔ |
| Combination therapy: Ampicillin◊ 200 to 300 mg/kg per 24 hours IV divided in 4 or 6 divided doses (maximum dose: 12 g per 24 hours) for 4 weeksΔ plus Gentamicin¥ 3 to 6 mg/kg per 24 hours IV in 3 divided doses for 4 weeksΔ | ||
The doses in this table are intended for patients with normal kidney function. The doses of many of these agents must be adjusted in the setting of kidney function impairment; refer to the individual drug monographs included within UpToDate for renal dosing adjustments.
Wherever intramuscular administration is provided as an alternative, intravenous route is preferred, particularly in infants and children.AHA: American Heart Association; ESC: European Society of Cardiology; IV: intravenously; NVE: native valve endocarditis.
* Haemophilus parainfluenzae, Aggregatibacter aphrophilus (formerly Haemophilus aphrophilus), Aggregatibacter actinomycetemcomitans (formerly Actinobacillus actinomycetemcomitans), Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae.
¶ Ceftriaxone is preferred. Cefotaxime or another third- or fourth-generation cephalosporin may be substituted. Patients who do not tolerate ceftriaxone should be treated in consultation with an infectious diseases specialist.
Δ The AHA and ESC favor 4 weeks of therapy for NVE.
◊ If growth in vitro is adequate to obtain definitive susceptibility testing results and susceptibility to ampicillin has been demonstrated (ie, non-beta-lactamase-producing organism).
§ Fluoroquinolone therapy recommended for patients unable to tolerate cephalosporin or ampicillin therapy; levofloxacin or moxifloxacin may be substituted. Fluoroquinolone therapy is not generally recommended for patients <18 years.
¥ Kidney function and gentamicin serum concentrations should be monitored at least once per week. In adults, aminoglycosides are dosed based on ideal body weight. Gentamicin dosage adjusted for peak serum concentrations 3 to 4 mcg/mL, trough <1 mcg/mL when 2 to 3 divided doses used.