What are the alternative treatments to -lactam therapy for MSSA IE?
Vancomycin is often recommended as an alternative to -lactam therapy for MSSA IE. Clindamycin has been associated with IE relapse and is not recommended as an alternative. For MSSA IE in patients with anaphylactoid-type -lactam allergy, -lactam desensitization should be considered. Daptomycin is also a reasonable alternative to vancomycin for adults in the treatment of S aureus NVE. The FDA-approved dose of daptomycin for S aureus bacteremia and right-sided IE is currently 6 mg/kg IV once daily. However, for left-sided IE, the FDA indication for daptomycin explicitly omitted left-sided IE due to insufficient data and the emergence of organisms with decreased susceptibility to daptomycin was observed in 5% of daptomycin-treated patients.