Faculty Opinions recommendation of Daptomycin versus standard therapy for bacteremia and endocarditis caused by Staphylococcus aureus.

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Abstract
This randomized controlled trial suggests that daptomycin may be a new alternative to conventional antibiotics for the treatment of bacteraemia due to Staphylococcus aureus if conventional alternatives cannot be given. In 235 patients, outcomes at 42 days were similar in patients treated with daptomycin (n=120) to vancomycin or an antistaphylococcal penicillin (n=115) (44% versus 42%, 95% CI for absolute diff -10%, +15%). Significant adverse events associated with daptomycin included elevations of creatine kinase and a temporary peripheral neuropathy. Limitations of the trial included a lack of blinding, a relatively small study size, limited numbers of patients with endocarditis and the observation of treatment-emergent resistance to daptomycin. This trial suggests that daptomycin may be a second line option for treatment of S. aureus bacteraemia, but careful monitoring of response and for side effects is required.

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