Fowler Daptomycin
Daptomycin versus Standard Therapy for Bacteraemia and Endocarditis Caused by Staphylococcus aureus
Doente / População Intervenção / Exposição Comparação Desfecho
In 246 patients with Staphylococcus aureus bacteraemia with or without endocarditis, daptomycin was non-inferior to an antistaphylococcal penicillin or vancomycin plus initial low-dose gentamicin for treatment success 42 days after the end of therapy, with less renal toxicity.
N
246
Desenho
Open-label non-inferiority RCT
Desfecho
Treatment success 42 days after the end of therapy
Relevância
2
Resultado44.2 % vs 41.7 % (absolute difference 2.4 %; 95 % CI −10.2 to 15.1) — non-inferiority met. Clinically significant renal dysfunction 11.0 % vs 26.3 % (p=0.004).
Fowler VG Jr, Boucher HW, Corey GR, et al. N Engl J Med. 2006;355(7):653-665. 10.1056/NEJMoa053783
Discussão e crítica
Open-label and underpowered for the endocarditis subgroup, most of which was right-sided, so left-sided and prosthetic-valve disease remain untested. The nephrotoxicity of its gentamicin-containing control arm is a principal reason routine aminoglycoside combination therapy was abandoned in native-valve staphylococcal endocarditis.