**5.2. Medical treatment**

Medical treatment for IE in HD patients, if considering the current guidelines for IE in general population, must have some important considerations in this group of patients.

Vancomycin should not be used in IE with MSSA, because of two reasons: (1) its low bactericidal activity when compared with oxacillin or cefazolin and (2) its main role in strains of *S. aureus* with reduced glycopeptides and vancomycin-resistant *Enterococci* sensitivity. Conversely, when dealing with a patient with IE with MRSA, vancomycin (possibly in combination with rifampicin)remains the drug of choice, if it is possible to obtain and maintain plasma levels between 15 and 20 mg/L without toxicity [5].
