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High-Dose Daptomycin Therapy for Staphylococcal Endocarditis and When to Apply It

  • Cardiovascular Infections (D Levine, Section Editor)
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Abstract

Infective endocarditis (IE) continues to present a large burden to the health-care system. Staphylococcus aureus, the leading pathogen associated with the disease, has always proven difficult to treat. Increasing numbers of S. aureus isolates are demonstrating reduced susceptibility to vancomycin, and therapeutic options are limited. Daptomycin is frequently employed when vancomycin therapy proves unsuccessful or when vancomycin minimum inhibitory concentration (MIC) values rise above 1 mg/L. Currently, daptomycin is FDA-approved at a dose of 6 mg/kg/day for the treatment of S. aureus bacteremia and associated right-sided endocarditis. However, numerous in vitro and clinical studies suggest that daptomycin doses up to 12 mg/kg/day may provide improved efficacy and resistance prevention. Additionally, high-dose daptomycin has demonstrated excellent safety. Together, these data suggest a role for high-dose daptomycin in staphylococcal IE patients who are severely ill, previously failed therapy with vancomycin, or possess a S. aureus isolate with an elevated vancomycin MIC.

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Acknowledgments

This article does not contain any studies with human or animal subjects performed by any of the authors. Michael J. Rybak is the guarantor of this article and takes responsibility for the integrity of the work as a whole.

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Conflict of Interest

Jordan Smith, Katie Barber, and Kimberly Claeys declare no conflicts of interest. Michael Rybak worked as a consultant for Durata, Trius, Cubist, Forest, Cepheid, and Theravance. Rybak received grants from Cubist, Forest, Cerexa, Trius, NIH, Michigan Department of Community Health, and Theravance. Rybak received speakers’ payment from Cubist, Forest, Novartis, Theravance and Sunovion and funding in part by NIH NIAID R21A1092055-01.

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This article does not contain any studies with human or animal subjects performed by the author.

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  1. Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, 48201, USA

    Jordan R. Smith, Kimberly C. Claeys, Katie E. Barber & Michael J. Rybak

  2. School of Medicine, Wayne State University, Detroit, MI, 48201, USA

    Michael J. Rybak

  3. Pharmacy Practice 4148, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA

    Michael J. Rybak

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  1. Jordan R. Smith
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Smith, J.R., Claeys, K.C., Barber, K.E. et al. High-Dose Daptomycin Therapy for Staphylococcal Endocarditis and When to Apply It. Curr Infect Dis Rep 16, 429 (2014). https://doi.org/10.1007/s11908-014-0429-6

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