In vitro activity of daptomycin in combination with β-lactams, gentamicin, rifampin, and tigecycline against daptomycin-nonsusceptible enterococci.
Hindler. Janet A JA; Wong-Beringer. Annie A; Charlton. Carmen L CL; Miller. Shelley A SA; Kelesidis. Theodoros T; Carvalho. Marissa M; Sakoulas. George G; Nonejuie. Poochit P; Pogliano. Joseph J; Nizet. Victor V; Humphries. Romney R
Key Findings
- Ampicillin plus daptomycin consistently synergized against daptomycin‑non‑susceptible enterococci with liaFSR mutations
- Ampicillin boosted the killing effect of the human peptide LL‑37 on resistant E. faecium regardless of mutation type
- Rifampin and tigecycline sometimes interfered with daptomycin activity (antagonism) in a few isolates
Practical Outcomes
- For clinicians, pairing ampicillin with daptomycin may improve outcomes for hard‑to‑treat VRE infections. For DIY health enthusiasts, the data suggest that ampicillin can enhance natural antimicrobial defenses in the lab, but there’s no safe, evidence‑based way to apply this at home yet.
Summary
The study shows that adding the antibiotic ampicillin to daptomycin makes the combo work better against tough, drug‑resistant gut bacteria, and it also helps the body’s own antimicrobial peptide LL‑37 kill these bugs. However, this is lab work, not a proven treatment you can use at home.
Abstract
Enterococci that are nonsusceptible (NS; MIC > 4 μg/ml) to daptomycin are an emerging clinical concern. The synergistic combination of daptomycin plus beta-lactams has been shown to be effective against vancomycin-resistant Enterococcus (VRE) species in vitro. This study systematically evaluated by in vitro time-kill studies the effect of daptomycin in combination with ampicillin, cefazolin, ceftriaxone, ceftaroline, ertapenem, gentamicin, tigecycline, and rifampin, for a collection of 9 daptomycin-NS enterococci that exhibited a broad range of MICs and different resistance-conferring mutations. We found that ampicillin plus daptomycin yielded the most consistent synergy but did so only for isolates with mutations to the liaFSR system. Daptomycin binding was found to be enhanced by ampicillin in a representative isolate with such mutations but not for an isolate with mutation to the yycFGHIJ system. In contrast, ampicillin enhanced the killing of the LL-37 human antimicrobial peptide against daptomycin-NS E. faecium with either the liaFSR or yycFGHIJ mutation. Antagonism was noted only for rifampin and tigecycline and only for 2 or 3 isolates. These data add support to the growing body of evidence indicating that therapy combining daptomycin and ampicillin may be helpful in eradicating refractory VRE infections.
Study Information
pubmed
2015
2015-05-11T00:00:00.000Z
10.1128/aac.05077-14