Thirteen studies were included: 2 retrospective (n=41) and 1 prospective (n=12) case series and 10 case studies (n=12).
Cure (3 case series, 10 case studies).
In the 3 case series, 81% (43 out of 53) patients were cured when daptomycin was administered, including all patients with osteomyelitis (n=23) and 60% of those with total joint arthroplasty infection (12 out of 20). The case studies reported that daptomycin as monotherapy cured 2 out of 8 patients; a further 2 patients were cured when vancomycin and rifampicin were added to daptomycin monotherapy. Daptomycin as part of combination therapy cured 3 out of 4 patients. Three of the 8 patients in whom treatment failed achieved full remission initially, but relapsed with MRSA after periods ranging from 12 days to 3 months.
Adverse events (3 case series, 10 case studies).
The case series reported little data on adverse events; nausea and elevated creatinine phosphokinase (CPK) levels were each reported in 1 patient in these studies. Seven case studies (n=7) reported this outcome. Four out of 7 patients reported adverse events associated with daptomycin, two of whom discontinued treatment. Adverse events included muscle pain and weakness, elevated CPK, elevated transaminases, acute renal failure (n=1) and creatinine disturbances.
Daptomycin resistance.
Daptomycin resistance was reported in only 1 patient in the 3 case series. Seven case studies assessed adverse events: 4 out of 7 patients with relevant reported data developed daptomycin resistance. This led to treatment failure in 3 patients and remission followed by relapse in one.