Daptomycin versus Standard Therapy for Bacteremia and Endocarditis Caused by Staphylococcus aureus

Background Alternative therapies for Staphylococcus aureus bacteremiaand endocarditisare needed. Methods We randomly assigned 124 patients with S. aureus bacteremiawith or without endocarditisto receive 6 mg of daptomycinintravenously per kilogramof body weight daily and 122 to receive initial low-dose gentamicin plus either an antistaphylococcal penicillinor vancomycin. The primary efficacy end point was treatment success 42 days after the end of therapy. Results Forty-two days after the end of therapy in the modified intention-to- treat analysis, a successful outcome was documented for 53 of 120 patients who received daptomycinas compared with 48 of 115 patients who received standard therapy (44.2 percent vs. 41.7 percent; absolute difference, 2.4 percent; 95 percent confidence interval, −10.2 to 15.1 percent). Our results met prespecified criteria for the noninferiority of daptomycin. The success rates were similar in subgroups of patients with complicated bacteremia, right-sided endocarditis, a...