Daptomycin in bone and joint infections: a review of the literature.
BACKGROUND
To review the pharmacology, pharmacokinetics, efficacy, and safety of daptomycin, a novel antibiotic for the treatment of bone and joint infections, a literature search of relevant articles was conducted.


METHODS
A PubMed/MEDLINE search (1990-April 2008) to identify relevant English-language literature was conducted. Search terms included bone and joint infection, osteomyelitis, daptomycin, and methicillin-resistant Staphylococcus aureus (MRSA). Additional articles were identified by reviewing the bibliographies of articles cited. Programs and abstracts from infectious disease meetings were searched, and prescribing information of antibiotics indicated for bone and joint infections consulted. All articles identified from data sources published in English were evaluated.


RESULTS
Caused primarily by Gram-positive pathogens such as S. aureus and, to a lesser extent, Enterococcus faecalis, bone and joint infections are difficult to treat successfully. Surgical intervention and prolonged courses of antibiotics are frequently required, and failure of first-line antibiotic therapy is common. The emergence of S. aureus strains with reduced susceptibility to vancomycin, the longstanding gold standard for bone and joint infections, has complicated the clinical scenario. Few randomized trials comparing the efficacy of different antibiotics for bone and joint infections exist. Daptomycin, a novel intravenous lipopeptide antibiotic, has shown potent in vitro activity against a broad spectrum of Gram-positive bacteria, including many resistant pathogens commonly associated with bone and joint infections such as MRSA and vancomycin-resistant E. faecalis. Early clinical investigation of daptomycin in bone and joint infections unresponsive to antibiotics, such as vancomycin, has found a cure rate of approximately 80%, with a low incidence of adverse events and drug resistance.


CONCLUSIONS
Further studies are warranted to determine if limited clinical evidence, described in individual case reports and a daptomycin-specific retrospective registry, suggests daptomycin is a promising option for patients with bone and joint infections such as MRSA osteomyelitis.
Rice
Dennis A K
DA
St Joseph's/Candler Health System, Savannah, GA, USA.
Mendez-Vigo
Luke
L
D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001843:Bone Cements; D001847:Bone Diseases / Q000188:drug therapy* / Q000382:microbiology; D017576:Daptomycin / Q000494:pharmacology / Q000627:therapeutic use*; D004337:Drug Carriers; D024881:Drug Resistance, Bacterial; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D007592:Joint Diseases / Q000188:drug therapy* / Q000382:microbiology; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects; D010019:Osteomyelitis / Q000188:drug therapy*; D019904:Polymethyl Methacrylate; D013203:Staphylococcal Infections / Q000188:drug therapy
D000900:Anti-Bacterial Agents; D001843:Bone Cements; D004337:Drug Carriers; D019904:Polymethyl Methacrylate; D017576:Daptomycin