Abstract:
Introduction: 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 1 g every 12 h or antistaphylococcal penicillin 2 g every 4 h, both with gentamicin 1 mg-kg every 8 h 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 (42percent vs 44percent). Patients with RIE with septic pulmonary infarcts responded similarly to treatment with daptomycin and standard therapy (60percent vs 67percent). In the LIE population, treatment success rates were poor in both arms (11percent vs 22percent). Conclusion: 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. © 2009 Elsevier España, S.L. All rights reserved.