What is the efficacy of combination beta-lactam antibiotics with daptomycin for the treatment of enterococcal infections?

Updated: Jun 10, 2021
  • Author: Susan L Fraser, MD; Chief Editor: John L Brusch, MD, FACP  more...
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It appears that combining various beta-lactam antibiotics with daptomycin may result in synergy against vancomycin-resistant E faecalis and E faecium. Ceftaroline and ampicillin are the most promising of the beta–lactams. [37, 38] Combining various antibiotics with daptomycin may restore the effectiveness of daptomycin against enterococci that have become resistant to it.

When the MIC is unknown or greater than 0.25 mg/L, high-dose daptomycin (10-12 mg/kg) in the treatment of enterococcal endocarditis appears to reduce the development of daptomycin-resistant strains. In addition, this enhanced dose would deal with the relative resistance of enterococcal isolates that have been previously exposed to vancomycin. [39]

Daptomycin has been demonstrated to be well tolerated and effective in patients with VRE UTI. [40]

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