Clinical utility of daptomycin in infective endocarditis caused by Gram-positive cocci
Clinical utility of daptomycin in infective endocarditis caused by Gram-positive cocci
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DOI：
10.1016/j.ijantimicag.2010.11.038
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发表时间：
2011-11-01
影响因子：
10.8
通讯作者：
Miro, Jose M.
中科院分区：
文献类型：
--
作者：
Cervera, Carlos;Castaneda, Ximena;Miro, Jose M.
革兰氏阳性菌占所有心内膜炎病例的80%以上。目前，葡萄球菌是全球心内膜炎的主要原因。达托霉素是经验性抗生素治疗葡萄球菌性心内膜炎的首选药物，因为它对甲氧西林敏感的金黄色葡萄球菌和耐甲氧西林的金黄色葡萄球菌都具有最佳活性。金黄色葡萄球菌（MRSA）菌株。达托霉素尚未被证明在治疗MRSA心内膜炎方面上级于万古霉素。然而，对于异质性万古霉素中间体S，达托霉素应被视为治疗由万古霉素最低抑制浓度（MIC）为2 μ g/mL的菌株引起的耐甲氧西林金黄色葡萄球菌心内膜炎的首选药物。金黄色葡萄球菌（hVISA）表型和糖肽中间体S.金黄色葡萄球菌（GISA）菌株。达托霉素是万古霉素治疗失败的MRSA心内膜炎的抢救治疗药物。尚未确定达托霉素的适当剂量;但是，对于左侧心内膜炎的治疗，达托霉素的剂量应高于推荐剂量6 mg/kg/天。联合抗生素治疗与达托霉素（e。G.联合磷霉素）是治疗MRSA心内膜炎的一种有希望的方法，值得进一步研究。体内研究表明，达托霉素在治疗耐甲氧西林凝固酶阴性葡萄球菌实验性心内膜炎方面上级万古霉素，但需要临床数据。达托霉素可能是万古霉素耐药屎肠球菌心内膜炎的有效治疗方法。最后，达托霉素的药代动力学特征使其成为门诊胃肠外抗菌治疗的优秀药物。(C)2011年Elsevier B. V.和国际化疗学会。All rights reserved.
Gram-positive bacteria account for >80% of all cases of endocarditis. Currently, staphylococci are the leading cause of endocarditis worldwide. Daptomycin is the drug of choice for empirical antibiotic therapy of staphylococcal endocarditis due to its optimal activity both against meticillin-susceptible Staphylococcus aureus and meticillin-resistant S. aureus (MRSA) strains. Daptomycin has not been proven to be superior to vancomycin in the treatment of MRSA endocarditis. However, daptomycin should be considered the drug of choice for the treatment of MRSA endocarditis caused by strains with a vancomycin minimum inhibitory concentration (MIC) of 2 mu g/mL, for heterogeneous vancomycin-intermediate S. aureus (hVISA) phenotypes and for glycopeptide-intermediate S. aureus (GISA) strains. Daptomycin is the drug of choice for rescue therapy in cases of MRSA endocarditis in which vancomycin has failed. The appropriate dose of daptomycin has not yet been established; however, for treatment of left-sided endocarditis the dose of daptomycin should be higher than the recommended dose of 6 mg/kg/day. Combination antibiotic therapy with daptomycin (e. g. combined with fosfomycin) is a promising treatment for MRSA endocarditis and warrants further investigation. In vivo studies show that daptomycin is superior to vancomycin in the treatment of meticillin-resistant coagulase-negative staphylococci experimental endocarditis, although clinical data are required. Daptomycin could represent an efficacious treatment for vancomycin-resistant Enterococcus faecium endocarditis. Finally, the pharmacokinetic profile of daptomycin makes it an excellent drug for outpatient parenteral antimicrobial therapy. (C) 2011 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.