Comments of Clinical and Microbiological Experience with Daptomycin in Chronic Osteomyelitis Treatment

The consideration for select daptomycin, a cyclic lipopeptide antibiotic drug, approved for complicated skin and soft tissue infections, right-sided infective endocarditis and bacteraemia due to Staphylococcus aureus [1], but not approved for use in bone infection; to treat a complex pathology like CO, comes from differents factors like daptomycin’s bactericidal activity against Gram-positive bacteria, including Methicillin-Resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant Enterococci (VRE), a novel mechanism of action that kills Grampositive bacteria by the disruption of multiple bacterial plasma membrane functions, without penetrating the cytoplasm [2]. Insertion of the lipophilic daptomycin tail into the bacterial cell membrane with oligomerization and channel formation causes rapid membrane depolarization and a potassium ion efflux. Arrest of DNA & RNA synthesis, toxin production, and protein synthesis follows, resulting in bacterial death without lysis of the cell wall, which gives a further advantage in diseases where inflammatory response associated counter antimicrobial use producing cell lysis [3-5], in addition, the in vitro potency of daptomycin has been demonstrated against Vancomycin resistant S. aureus (VRSA) and methicillin-resistant coagulase-negative staphylococci (MRCNS). The synergic effect for daptomycin that has been described in vitro with aminoglycosides (gentamicin), oxacillin, other betalactamics, macrolides and rifampicin, is very valuable to biofilm disease infections treatment, and this antibiofilm activity and reduction of the rifampicin resistance appearance makes a great value. Not antagonism interactions was observed with daptomycin use in combination with several antimicrobial agents, only additive, synergistic effect or indifference were reported. Another relevant aspect is the partial anti-biofilm activity of daptomycin, combined or alone.