Adding Ceftriaxone to Daptomycin for Managing Streptococcus mitis-oralis Endocarditis

In an animal model of S. mitis-oralis endocarditis, superior bacterial killing was achieved with daptomycin plus ceftriaxone versus daptomycin alone.

The Streptococcus mitis-oralis subgroup of viridans streptococci represent a significant cause of infective endocarditis (IE) worldwide. Reduced susceptibility as well as tolerance to conventional beta-lactams and vancomycin have placed an increasing burden on use of daptomycin (DAP), but loss of susceptibility has been noted with DAP monotherapy. Can this loss be averted with combination therapy?

Using two S. mitis-oralis strains with proclivity to develop DAP resistance in vitro, Mishra et al. compared DAP monotherapy (4–18 mg/kg daily) to DAP (4 and 8 mg/kg daily) plus ceftriaxone (CRO) in a rabbit model. They assessed clearance of bacteria from key target tissues and emergence of DAP resistance. Against both strains, DAP + CRO was signif…

Reviewing Author

George Sakoulas, MD

Disclosures

Consultant/Advisory BoardParatek Pharmaceuticals; Nestle Corp.; AbbVie; Shionogi

Speaker’s BureauAllergan/AbbVie; Paratek Pharmaceuticals; Nestle Corp.

RoyaltiesUpToDate

Editorial BoardsAntimicrobial Agents and Chemotherapy; Open Forum Infectious Diseases