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For decades, experts have endorsed the inclusion of low-dose aminoglycosides (AGs) in initial treatment for patients with Staphylococcus aureus bacteremia, especially when endocarditis is suspected. This practice made sense in light of strong in vitro evidence of antibiotic synergy and clinical data that showed that bacteremias cleared faster with two drugs; the downside of a few days of low-dose AG treatment seemed small. However, further analysis of an open-label international study (JW Sep 19 2006) forces reconsideration of this recommendation.
In the open-label study, the efficacy of daptomycin was compared with that of vancomycin and the antistaphylococcal penicillins (ASPs) in S. aureus bacteremia; vancomycin and ASP patients received …