JAC Advance Access originally published online on February 12, 2004
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Journal of Antimicrobial Chemotherapy (2004) 53, 530-532
© 2004 The British Society for Antimicrobial Chemotherapy
Daptomycin synergy with rifampicin and ampicillin against vancomycin-resistant enterococci
Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL 32610, USA
Received 28 August 2003; returned 29 October 2003; revised 5 December 2003; accepted 8 December 2003
We used a novel screening method to look for synergy between daptomycin and 18 other antibiotics against 19 strains of high-level vancomycin-resistant enterococci (VRE) (vancomycin MIC 
256 mg/L). In this approach, daptomycin was incorporated into Ca2+-supplemented Mueller–Hinton agar at subinhibitory concentrations, and synergy was screened by comparing test antibiotic Etest MICs on agar with and without daptomycin. A striking reduction in the rifampicin MIC was seen in 11/15 (73.3%) VRE that were resistant to rifampicin, from 12 mg/L to a mean ± S.D. of 0.22 ± 0.21 mg/L at daptomycin 0.25 x MIC and 0.85 ± 0.90 mg/L at daptomycin 0.125 x MIC. Synergy was also observed for 13/19 (68%) isolates with ampicillin (MIC 128 mg/L). There was no significant synergy between daptomycin and any other antibiotic by this screening method. If confirmed by further studies, daptomycin with either rifampicin or ampicillin may be useful in the management of infections caused by VRE.
Keywords: antibiotic synergy, Enterococcus, VRE
* Corresponding author. Tel: +1-352-392-5621; Fax: +1-352-392-4693; E-mail: Rand{at}pathology.ufl.edu
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