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Resumen
Las infecciones causadas por grampositivos son en la actualidad un problema terapéutico debido a la aparición y diseminación de cepas con resistencia múltiple a los antibióticos utilizados como primera elección. Los glucopéptidos, considerados como fármacos alternativos, tienen una eficacia limitada para el tratamiento de las infecciones graves causadas por estos microorganismos, incluida la endocarditis infecciosa. Entre los nuevos antimicrobianos, aprobados recientemente para su uso en terapéutica, la daptomicina ofrece un buen perfil de eficacia clínica, tanto en ensayo clínico como en experiencias de uso clínico recogidas después de su autorización. Su actividad bactericida y su potencial sinérgico con otros antibióticos, betalactámicos, fosfomicina o aminoglucósidos, la sitúan entre los tratamientos de elección para las infecciones causadas por estafilococos y probablemente enterococos con resistencia múltiple a los antibióticos. La daptomicina ofrece, además, un excelente perfil de seguridad y una tasa muy reducida de resistencias. En nuevos estudios, que incluyan a numerosos pacientes con esta grave infección, se ha de establecer con precisión la eficacia clínica del fármaco para esta indicación terapéutica.
Palabras clave:
Endocarditis infecciosa
Daptomicina
Terapéutica
Abstract
Infections caused by Gram-positive organisms are currently a therapeutic problem because of the emergence and spread of strains with multiple resistance to antibiotics used as first-line therapeutic options. Glycopeptides, considered as alternative drugs, have limited effectiveness in the treatment of serious infections caused by these microorganisms, including infective endocarditis. Among the new antimicrobial agents recently licensed for use in human therapy, daptomycin offers a good clinical efficacy profile in both clinical trials and in experiences of clinical use registered after approval. Because of its bactericidal activity and potential synergy with other antimicrobial agents, such as beta-lactams, fosfomycin and aminoglycosides, daptomycin is among the first-line options in the treatment of infections caused by staphylococci and probably enterococci with multiple resistance to antibiotics. Daptomycin also offers an excellent safety profile and a very low rate of resistance. Further studies, including many patients with this serious infection, should precisely determine the clinical efficacy of daptomycin in this indication.
Keywords:
Infective endocarditis
Daptomycin
Therapeutic options
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