Vancomycin-resistant enterococci (VRE) infections can mostly be treated with antibiotics other than vancomycin, and laboratory tests can be performed to identify optimal treatment regimens. Daptomycin is one antibiotic with known in vitro activity against VRE. Daptomycin and vancomycin have different bactericidal mechanisms of action; specifically, daptomycin works by binding or inserting into the outer membrane, while vancomycin inhibits cell wall synthesis. Other possible options for treating VRE include linezolid, tigecycline, oritavancin, televancin, and a combination of quinupristin and dalfopristin. This Rapid Response report aims to review the comparative clinical- and cost-effectiveness of daptomycin for patients with VRE infections. Evidence-based guidelines on the optimal use of daptomycin in patients with VRE infections will also be summarized.

Contents

• CONTEXT AND POLICY ISSUES
• RESEARCH QUESTIONS
• KEY FINDINGS
• METHODS
  • Literature Search Methods
  • Selection Criteria and Methods
  • Exclusion Criteria
  • Critical Appraisal of Individual Studies
• SUMMARY OF EVIDENCE
  • Quantity of Research Available
  • Summary of Study Characteristics
  • Summary of Critical Appraisal
  • Summary of Findings
  • Limitations
• CONCLUSIONS AND IMPLICATIONS FOR DECISION OR POLICY MAKING
• REFERENCES
• APPENDIX 1 Selection of Included Studies
• APPENDIX 2 Additional References of Potential Interest
• APPENDIX 3 Characteristics of Included Publications
• APPENDIX 4 Critical Appraisal of Included Publications
• APPENDIX 5 Main Study Findings and Author’s Conclusions

Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. Rapid responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report.