Daptomycin for enterococcal bacteraemia: a case for higher doses while breakpoints disagree

The edition in brief

Today's infectious diseases edition closes on daptomycin for serious enterococcal infection. It is widely used but has no FDA or EMA approval for this indication, CLSI and EUCAST disagree on breakpoints, and observational data link 10–12 mg/kg per day with lower mortality in vancomycin-resistant E faecium. The authors propose at least 8 mg/kg per day for E faecium, 10–12 mg/kg for vancomycin-resistant disease, a beta-lactam partner in endocarditis and weekly creatine kinase checks. A meta-analysis of 23 studies and 5,734 patients in low- and lower-middle-income countries put the pooled prevalence of depression in multidrug-resistant tuberculosis at about 42%, with stigma, comorbidity, drug side effects and financial hardship among the associated factors. A global meta-analysis of 349 studies estimated vancomycin resistance in 25% of E faecium and 5% of E faecalis isolates, rising over two decades. In a prospective study, recombinant zoster vaccine produced seroconversion in 91.9% of patients with autoimmune rheumatic disease on intravenous cyclophosphamide, similar to patients not on it. The pearl is a reminder of where daptomycin does not work.