Use of Daptomycin to Manage Severe MRSA Infections in Humans
Methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) represents a major therapeutic challenge due to its multidrug-resistance and the associated clinical burden. Daptomycin (DAP), a cyclic lipopeptide antibiotic, has become a key agent for the treatment of severe MRSA infections owi...
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MDPI AG
2025-06-01
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| Series: | Antibiotics |
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| author | Marco Fiore Aniello Alfieri Daniela Fiore Pasquale Iuliano Francesco Giuseppe Spatola Andrea Limone Ilaria Pezone Sebastiano Leone |
| author_facet | Marco Fiore Aniello Alfieri Daniela Fiore Pasquale Iuliano Francesco Giuseppe Spatola Andrea Limone Ilaria Pezone Sebastiano Leone |
| author_sort | Marco Fiore |
| collection | DOAJ |
| description | Methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) represents a major therapeutic challenge due to its multidrug-resistance and the associated clinical burden. Daptomycin (DAP), a cyclic lipopeptide antibiotic, has become a key agent for the treatment of severe MRSA infections owing to its rapid bactericidal activity and favourable safety profile. In this narrative review, we examine studies published between 2010 and April 2025. The data suggest that treatment with high-dose (8–10 mg kg⁻<sup>1</sup>) DAP shortened the time to blood-culture sterilisation by a median of 2 days compared with standard-dose vancomycin without increasing toxicity when model-informed area-under-the-curve monitoring was employed. Particular attention is given to the synergistic effects of DAP combined with fosfomycin or β-lactams, especially ceftaroline and ceftobiprole, in overcoming persistent and refractory MRSA infections; this approach results in a reduction in microbiological failure relative to monotherapy. Resistance remains uncommon (<2% of isolates), but recurrent mutations in <i>mprF</i>, <i>liaFSR</i>, and <i>walK</i> underscore the need for proactive genomic surveillance. Despite promising preclinical and clinical evidence supporting combination strategies, further randomized controlled trials are necessary to establish their definitive role in clinical practice, as are head-to-head cost-effectiveness evaluations. DAP remains a critical option in the evolving landscape of MRSA management, provided its use is integrated with precision dosing, resistance surveillance, and antimicrobial-stewardship frameworks. |
| format | Article |
| id | doaj-art-c33caef8e2ce4cfb92eaea168f487c33 |
| institution | OA Journals |
| issn | 2079-6382 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj-art-c33caef8e2ce4cfb92eaea168f487c332025-08-20T02:24:30ZengMDPI AGAntibiotics2079-63822025-06-0114661710.3390/antibiotics14060617Use of Daptomycin to Manage Severe MRSA Infections in HumansMarco Fiore0Aniello Alfieri1Daniela Fiore2Pasquale Iuliano3Francesco Giuseppe Spatola4Andrea Limone5Ilaria Pezone6Sebastiano Leone7Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, ItalyDepartment of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, ItalyAnesthesia and Intensive Care Unit, ASUR Marche, Area Vasta n. 4, Via Murri, 63023 Fermo, ItalyDepartment of Internal Medicine, Infectious Diseases Section, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, ItalyDepartment of Internal Medicine, Infectious Diseases Section, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, ItalyDepartment of Internal Medicine, Infectious Diseases Section, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, ItalyDepartment of Pediatrics, “San Giuseppe Moscati” Hospital, 81031 Aversa, ItalyDepartment of Internal Medicine, Infectious Diseases Section, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, ItalyMethicillin-resistant <i>Staphylococcus aureus</i> (MRSA) represents a major therapeutic challenge due to its multidrug-resistance and the associated clinical burden. Daptomycin (DAP), a cyclic lipopeptide antibiotic, has become a key agent for the treatment of severe MRSA infections owing to its rapid bactericidal activity and favourable safety profile. In this narrative review, we examine studies published between 2010 and April 2025. The data suggest that treatment with high-dose (8–10 mg kg⁻<sup>1</sup>) DAP shortened the time to blood-culture sterilisation by a median of 2 days compared with standard-dose vancomycin without increasing toxicity when model-informed area-under-the-curve monitoring was employed. Particular attention is given to the synergistic effects of DAP combined with fosfomycin or β-lactams, especially ceftaroline and ceftobiprole, in overcoming persistent and refractory MRSA infections; this approach results in a reduction in microbiological failure relative to monotherapy. Resistance remains uncommon (<2% of isolates), but recurrent mutations in <i>mprF</i>, <i>liaFSR</i>, and <i>walK</i> underscore the need for proactive genomic surveillance. Despite promising preclinical and clinical evidence supporting combination strategies, further randomized controlled trials are necessary to establish their definitive role in clinical practice, as are head-to-head cost-effectiveness evaluations. DAP remains a critical option in the evolving landscape of MRSA management, provided its use is integrated with precision dosing, resistance surveillance, and antimicrobial-stewardship frameworks.https://www.mdpi.com/2079-6382/14/6/617methicillin-resistant <i>Staphylococcus aureus</i>daptomycinantibiotic resistancecombination therapybacteremia |
| spellingShingle | Marco Fiore Aniello Alfieri Daniela Fiore Pasquale Iuliano Francesco Giuseppe Spatola Andrea Limone Ilaria Pezone Sebastiano Leone Use of Daptomycin to Manage Severe MRSA Infections in Humans Antibiotics methicillin-resistant <i>Staphylococcus aureus</i> daptomycin antibiotic resistance combination therapy bacteremia |
| title | Use of Daptomycin to Manage Severe MRSA Infections in Humans |
| title_full | Use of Daptomycin to Manage Severe MRSA Infections in Humans |
| title_fullStr | Use of Daptomycin to Manage Severe MRSA Infections in Humans |
| title_full_unstemmed | Use of Daptomycin to Manage Severe MRSA Infections in Humans |
| title_short | Use of Daptomycin to Manage Severe MRSA Infections in Humans |
| title_sort | use of daptomycin to manage severe mrsa infections in humans |
| topic | methicillin-resistant <i>Staphylococcus aureus</i> daptomycin antibiotic resistance combination therapy bacteremia |
| url | https://www.mdpi.com/2079-6382/14/6/617 |
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