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.