Penicillin is the drug of choice for patients with viridans streptococcal SBE, although ampicillin is a suitable alternative. An aminoglycoside often is administered concurrently for several days for synergistic bacterial killing. Vancomycin is utilized in patients with a significant penicillin or cephalosporin allergy but is not as effective. Erythromycin, aztreonam, and itraconazole are not appropriate in this setting.
