Nouvelles associations dans le traitement des infections graves à cocci à Gram positif

The efficacy of novel antibiotic combinations for the treatment of severe infections due to Gram-positive cocci has been recently evaluated both in vitro and in experimental animal models, but few clinical data are currently available. For MRSA, daptomycin in combination with rifampin and fosfomycin is promising for the treatment of foreign-body infections (biofilm). The combination of daptomycin with some beta-lactams appears to be potent against daptomycin-nonsusceptible strains of MRSA and may prevent the development of daptomycin-resistance. For Enterococcus faecalis, a synergist effect of amoxicillin and third-generation cephalosporins, previously demonstrated in vitro, has been recently shown to be effective in clinical studies for the treatment of infective endocarditis, particularly for patients infected with high-level aminoglycoside resistant strains. For Enterococcus faecium, if the combinations of daptomycin with rifampin, gentamicin and ampicillin are synergistic, the place of these associations remains to be determined in clinical practice.