Daptomycin for endocarditis and/or bacteraemia: a systematic review of the experimental and clinical evidence
Background: Endocarditis and bacteraemia are devastating infections with high mortality. Grampositive
cocci are the most commonly isolated pathogens. In an era of multidrug-resistant pathogens,
the evaluation of new treatment options is important. Daptomycin is a cyclic lipopeptide that is active
against most of these pathogens. Furthermore, it is a bactericidal antibiotic, a factor that is frequently
considered in the choice of treatment of patients with bacteraemia and endocarditis.
Methods: We performed a systematic review of the evidence for the effectiveness of daptomycin in the
treatment of patients and animals with endocarditis and/or bacteraemia. We searched PubMed and
Scopus databases for relevant studies. Case reports, case series, controlled trials, randomized
controlled trials and comparative studies using experimental animal models were included.
Results: The most reliable information comes from the single multicentre randomized controlled trial
conducted on this issue, which showed that daptomycin is a promising antibiotic for the treatment of
patients with Staphylococcus aureus bacteraemia and endocarditis. The experimental models indicate
that the combination of daptomycin with rifampicin or gentamicin can improve outcomes further.
Finally, in several of the published relevant case reports daptomycin was administered in patients with
haematological malignancies.
Conclusions: Daptomycin is a promising antibiotic that has been already approved for the treatment of
patients with right-sided endocarditis and bacteraemia. However, the available clinical evidence is
limited and further evaluation of the antibiotic is warranted. The commonly reported de novo development
of resistance is a major concern that may limit its use. More controlled trials are needed,
especially for patients infected with multidrug-resistant Gram-positive cocci, comparing daptomycin
with other available treatment options, including glycopeptides and oxazolidinones.