Use of daptomycin in complicated cases of infective endocarditis

Infective endocarditis (IE) is a serious form of infection with a high mortality. Medical management can be a challenge because of organ dysfunction, lack of clinical response or allergy to the recommended antibiotics. Daptomycin is a lipopeptide antibiotic with a potent bactericidal activity against Gram-positive bacteria. There are limited data on the use of daptomycin in complicated cases of IE. We aim to report our experience of daptomycin use in complicated cases of IE through a prospective observational study (from 1 October 2008 to 30 September 2009). Daptomycin was prescribed for cases that were either unresponsive or allergic to the standard therapy. Clinical characteristics and outcomes were reviewed. Success was defined as clinical improvement accompanied with the resolution of laboratory markers of sepsis and continuation of the above findings for at least 8 weeks after the end of therapy. Eight cases were evaluable. Native and prosthetic valves were involved in equal proportions. The range of organisms was wide: Staphylococcus aureus, two cases; S. epidermidis, two cases; streptococci, two cases; and Enterococcus faecalis, two cases. The median duration of therapy was 42 days. All patients were successfully treated. Daptomycin was well tolerated. Daptomycin is useful in the management of complicated cases of IE.