Daptomycin compared to standard therapy for the treatment of native valve endocarditis.
BACKGROUND
In a recent randomized trial of Staphylococcus aureus bacteremia and native valve endocarditis, daptomycin was found not inferior to standard therapy. We summarized findings in the subgroup of patients with endocarditis according to the Duke criteria.


METHODS
Patients were randomly assigned to receive daptomycin 6 mg/kg/day or standard therapy (vancomycin 1g every 12h or antistaphylococcal penicillin 2g every 4h, both with gentamicin 1mg/kg every 8h for the first 4 days). The primary end point was success in the modified intent-to-treat population 6 weeks after the end of therapy.


RESULTS
Fifty-three patients were included: 35 with right-sided endocarditis (RIE) and 18 with left-sided endocarditis (LIE). The success rates in patients with RIE were similar between daptomycin and the comparator (42% vs 44%). Patients with RIE with septic pulmonary infarcts responded similarly to treatment with daptomycin and standard therapy (60% vs 67%). In the LIE population, treatment success rates were poor in both arms (11% vs 22%).


CONCLUSIONS
Daptomycin is an efficacious and well-tolerated alternative to standard therapy in the treatment of RIE. Patients with LIE had a poor outcome regardless of the treatment received. Daptomycin is also effective in treating endocarditis with septic pulmonary infarcts.
Kanafani
Zeina
Z
American University of Beirut Medical Center, Beirut, Líbano.
Boucher
Helen
H
Fowler
Vance
V
Cabell
Christopher
C
Hoen
Bruno
B
Miró
José M
JM
Lalani
Tahaniyat
T
Vigliani
Gloria
G
Campion
Marilyn
M
Corey
Ralph
R
Levine
Donald
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017576:Daptomycin / Q000627:therapeutic use*; D004311:Double-Blind Method; D004697:Endocarditis, Bacterial / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
D000900:Anti-Bacterial Agents; D017576:Daptomycin