Should High-dose Daptomycin be an Alternative Treatment Regimen for Enterococcal Endocarditis?

Area of Science:

• Infectious Diseases
• Cardiology
• Pharmacology

Background:

• Enterococcal infective endocarditis (EIE) has been associated with high mortality rates in previous studies.
• Daptomycin is an antibiotic used for treating Gram-positive bacterial infections, including EIE.

Purpose of the Study:

• To analyze the effectiveness of high-dose daptomycin for treating EIE.
• To compare daptomycin-based regimens (DBR) with daptomycin-sparing regimens (DSR).
• To evaluate risk factors for 30-day mortality and end-of-therapy failure.

Main Methods:

• Prospective study of 43 EIE patients (native and prosthetic valves) from 2010-2018.
• Administered high-dose daptomycin (10-12 mg/kg/day) in a daptomycin-based regimen (DBR).
• Compared DBR with daptomycin-sparing regimen (DSR), and daptomycin monotherapy versus combination therapy.

Main Results:

• No significant difference in 30-day mortality or end-of-therapy failure between DBR and DSR groups (6.2% vs. 22.2%; P=0.41).
• No difference in outcomes for native valve endocarditis (NVE) and prosthetic valve endocarditis (PVE) subgroups.
• Daptomycin was primarily used in combination with ß-lactam (43.7% of DBR cases).

Conclusions:

• High-dose daptomycin can be considered an alternative treatment for EIE.
• Further research may explore optimal daptomycin dosing and combination therapies for EIE.