1. The Combination of Daptomycin and Fosfomycin Has Synergistic, Potent, and Rapid Bactericidal Activity against Methicillin-Resistant Staphylococcus aureus in a Rabbit Model of Experimental Endocarditis
- Author
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Cristina García-de-la-Mària, Oriol Gasch, Javier García-Gonzalez, Dolors Soy, Evelyn Shaw, Juan Ambrosioni, Manel Almela, Juan M. Pericàs, Adrián Tellez, Carlos Falces, Marta Hernandez-Meneses, Elena Sandoval, Eduard Quintana, Barbara Vidal, Jose M. Tolosana, David Fuster, Jaume Llopis, Miquel Pujol, Asuncion Moreno, Francesc Marco, Jose M. Miró, Adrian Téllez, Marta Hernández-Meneses, Cristina García de la Mària, Yolanda Armero, Javier García-González, Climent Casals, Jordi Vila, Juan C. Paré, Daniel Pereda, Ramon Cartañá, Salvador Ninot, Manel Azqueta, Marta Sitges, José L. Pomar, Manuel Castella, José M. Tolosana, José Ortiz, Guillermina Fita, Irene Rovira, Jose Ramírez, Mercè Brunet, and Pedro Castro
- Subjects
0301 basic medicine ,Methicillin-Resistant Staphylococcus aureus ,medicine.drug_class ,030106 microbiology ,Antibiotics ,Microbiologia ,Fosfomycin ,medicine.disease_cause ,Microbiology ,03 medical and health sciences ,0302 clinical medicine ,Cloxacillin ,Daptomycin ,medicine ,polycyclic compounds ,Endocarditis ,Animals ,Humans ,Pharmacology (medical) ,Experimental Therapeutics ,030212 general & internal medicine ,Pharmacology ,business.industry ,Drug Synergism ,Endocarditis, Bacterial ,biochemical phenomena, metabolism, and nutrition ,medicine.disease ,bacterial infections and mycoses ,Methicillin-resistant Staphylococcus aureus ,Anti-Bacterial Agents ,Infectious Diseases ,Staphylococcus aureus ,Vancomycin ,lipids (amino acids, peptides, and proteins) ,Female ,Rabbits ,business ,medicine.drug - Abstract
We investigated whether the addition of fosfomycin or cloxacillin to daptomycin provides better outcomes in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) experimental aortic endocarditis in rabbits. Five MRSA strains were used to perform in vitro time-kill studies using standard (10 6 ) and high (10 8 ) inocula. Combined therapy was compared to daptomycin monotherapy treatment in the MRSA experimental endocarditis model. A human-like pharmacokinetics model was applied, and the equivalents of cloxacillin at 2 g/4 h, fosfomycin at 2 g/6 h, and daptomycin at 6 to 10 mg/kg/day were administered intravenously. A combination of daptomycin and either fosfomycin or cloxacillin was synergistic in the five strains tested at both inocula. A bactericidal effect was detected in four of five strains tested with both combinations. The MRSA-277 strain (vancomycin MIC, 2 μg/ml) was used for the experimental endocarditis model. Daptomycin plus fosfomycin significantly improved the efficacy of daptomycin monotherapy at 6 mg/kg/day in terms of both the proportion of sterile vegetations (100% versus 72%, P = 0.046) and the decrease in the density of bacteria within the vegetations ( P = 0.025). Daptomycin plus fosfomycin was as effective as daptomycin monotherapy at 10 mg/kg/day (100% versus 93%, P = 1.00) and had activity similar to that of daptomycin plus cloxacillin when daptomycin was administered at 6 mg/kg/day (100% versus 88%, P = 0.48). Daptomycin nonsusceptibility was not detected in any of the isolates recovered from vegetations. In conclusion, for the treatment of MRSA experimental endocarditis, the combination of daptomycin plus fosfomycin showed synergistic and bactericidal activity.
- Published
- 2017