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Viridans Streptococci or S. bovis PVE, Penicillin MIC >0.12 μg/ml, Pediatric Preferred Regimen ▸ Penicillin G 0.3 MU/kg/day IV q4—6h x 6 weeks OR ▸ Ceftriaxone 100 mg/kg IV/IM q24h x 6 weeks PLUS ▸ Gentamicin 3 mg/kg IV q24h (or 1 mg/kg IV q8h) x 6 weeks¶ Alternative Regimen ▸ Vancomycin 40 mg/kg/day IV q8—12h x 6 weeksǁ ¶ Gentamicin dosage should be adjusted to achieve peak serum concentration of 3—4 μg/ml and trough serum concentration of less than 1 μg/ml when 3 divided doses are used; nomogram used for single daily dosing; other potentially nephrotoxic drugs (e.g., nonsteroidal anti-inflammatory drugs) should be used with caution in patients receiving gentamicin therapy. ǁ Recommended only for patients unable to tolerate penicillin or ceftriaxone. Vancomycin doses should not exceed 2 g per 24 h, unless serum concentrations are inappropriately low. Dosage should be adjusted to obtain peak (1 h after infusion completed) serum concentration of 30–45 μg/ml and a trough concentration range of 10–15 μg/ml. Vancomycin should be infused during course of at least 1 h to reduce risk of histamine-release red man syndrome.