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Six weeks of nafcillin (or equivalent antistaphylococcal penicillin) is recommended for uncomplicated left-sided NVE caused by MSSA; at least 6 weeks of nafcillin (or equivalent antistaphylococcal penicillin) is recommended for complicated left-sided NVE caused by this organism ( Class I; Level of Evidence C).

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These modifications require further validation among patients who are hospitalized in both community-based and tertiary care hospitals, with particular attention to longer-term follow-up of patients rejected as having IE because they did not meet the minimal floor criteria for possible IE.

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Although the 2007 guidelines are a marked improvement because they prioritize the cardiac conditions and procedures that require antibiotic prophylaxis and emphasize the importance of promoting good oral hygiene, they offer little direction in dealing with the ever-growing problem of antibiotic-resistance patterns of S viridans and enterococci.

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