Comment on: Efficacy and safety of daptomycin for the treatment of infectious disease: a meta-analysis based on randomized controlled trials.

To elaborate, during his therapy , our patient was diligently monitored weekly and C-reactive protein was used as a surrogate marker of response, which decreased from an intimal measure of 30.1 mg/L to 6.2 mg/L by week 9, a point at which we could not justify prolonging the treatment further. We emphasize that our patient's treatment comprised doses of daptomycin (8 mg/kg daily) and ceftriaxone (2 g twice daily) higher than those shown to be sufficient for synergy. 6 Although we cannot directly specify the cause of death, this regi-men was clearly insufficient to attain microbiological cure, evi-denced by relapse occurring almost immediately after stopping treatment and the isolation of bacteria from blood cultures and from the patient's valve tissue days later. We were surprised to find that the organism's MIC of daptomycin increased 4-fold while on treatment, which strongly suggests that the development of resistance probably contributed to treatment failure despite the high doses of both daptomycin and ceftriaxone. Although this case resulted in our patient expiring, we stand beside our clinical decisions, as well as those leading us to submit our case for publication. The work by Hall Snyder et al. 6 describing synergy between daptomycin and ceftriaxone is of high quality and offers a microbiologically sound therapeutic option where first-line therapies are not feasible. Publishing our case marked the transition from the laboratory to clinical practice, and despite possessing biases intrinsic to case reports, it stands as a valid addition to the medical literature and not as a platform to criticize desperately needed research for novel therapies. In fact, we had made an a priori decision to submit this case for publication, and, having obtained signed patient consent at the beginning of treatment , we would have objectively reported any outcome observed, positive or negative. While we agree with Hall Snyder et al. 1 that our experience with this regimen, along with any other non-randomized research on daptomycin against Enterococcus, should be interpreted with caution when making therapeutic decisions , we also respectfully underscore the bias inherent to research from laboratories funded by the pharmaceutical industry. Nevertheless, we feel that we speak for many clinicians who manage challenging infections such as enterococcal IE, look forward to the results of future evidence, be it laboratory or clinical, regarding novel therapies, and encourage those with unreported clinical experience to submit their data for publication. References 1 Hall Snyder A, …