Table 3.

Studies evaluating daptomycin in combination with cephalosporins and cephalosporins + BLIs

StrainYear and countryNumber of isolatesResistance (%)In vitro (methods)/in vivo (animal and site of infection)Partner drugSynergistic effect (%)Additive effect (%)Indifferent effect (%)Antagonistic effect (%)CommentsReference
SA2005, USA2MRSA (100)in vitro (PK/PD model)Cefepime2 (100)34
SA2005, USA40MRSA (50)in vitro (ET) (TK on 1 MRSA)CefepimeET: 2 (5); TK: 1 (100)ET: 38 (95)No distinction between additive and indifferent effect.14
in vitro (ET)CeftriaxoneET: 1 (2.5)ET: 39 (97.5)
E. faecalis, E. faecium40VRE (50)in vitro (ET) (TK on 1 VSE)CefepimeET: 9 (22.5)ET: 31 (77.5); TK: 1 (100)
in vitro (ET) (TK on 2 VSE and 1 VRE)CeftriaxoneET: 18 (45)ET: 22 (55); TK: 3 (100)
SA2010, USA2MRSA (100)in vitro (PD model)Cefepime1 (50)1 (50)DNS isolates. High inoculum tested.19
SA2013, USA2hVISA (50)in vitro (PK/PD model)Ceftaroline2 (100)Two isogenic isolates, one of which mutated into a hVISA DNS strain. High inoculum tested.35
SA2014, USA3MRSA (66.7), hVISA (33.3)in vitro (biofilm model)Ceftaroline, cefazolin3 (100)Synergy was observed against all isolated for both combinations.36
SA2014, USA3VISA (100)in vitro (PK/PD model)Ceftaroline2 (66.7)1 (33.3)DNS isolates. High inoculum tested.37
E. faecium2014, USA2VRE (100)in vitro (PK/PD model)Ceftriaxone1 (50)1 (50)High inoculum tested.38
E. faecalis1Ceftriaxone1 (100)
SA2014, USA2MRSA (50)in vitro (CB, TK)Ceftaroline2 (100)39
SA2014, USA5MRSA (60); VISA (40)in vitro (TK)Ceftobiprole5 (100)40
SA2015, USA1MRSA (100)in vitro (PK/PD model)Ceftaroline1 (100)41
E. faecalis2015, USA2VRE (100)in vitro (CB, TK)Ceftaroline2 (100)25
2Cefepime1 (50)1 (50)
2Ceftriaxone1 (50)1 (50)
2Cefotaxime1 (50)1 (50)
2Cefazolin2 (100)
E. faecium2Ceftaroline2 (100)
2Cefepime1 (50)1 (50)
2Ceftriaxone1 (50)1 (50)
2Cefotaxime1 (50)1 (50)
2Cefazolin1 (50)1 (50)
E. faecium2015, USA4VRE (100)in vitro (TK)Ceftobiprole2 (50)2 (50)DNS isolates.26
E. faecalis2Ceftobiprole2 (100)
E. faecalis2015, USA1VRE (100)in vitro (PK/PD model)Ceftaroline1 (100)27
E. faecium2Ceftaroline2 (100)
Enterococcus spp.2015, USA9VRE (88.9) (2 E. faecalis, 7 E. faecium)in vitro (TK)Ceftriaxone4 (44.4)5 (55.6)DNS isolates.42
9Cefazolin2 (22.2)7 (77.8)
9Ceftaroline5 (55.6)4 (44.4)
SA2015, USA3MRSA (100)in vitro (PK/PD biofilm model)Ceftaroline3 (100)43
SA2016, USA2MRSA (100)in vitro (Hollow-fibre model)Cefazolin2 (100)Isogenic pair of DAP-susceptible and DNS isolates. High inoculum tested.44
2Ceftolozane/tazobactam1 (50)1 (50)
SA2016, USA1MRSA (100)in vivo (rabbit, IE, spleen and kidney dissemination)Ceftriaxone1 (100)Synergistic effect on spleen. In the in vivo study, equivalent human dosage of DAP 12 mg/kg was administered.45
SA2016, Spain71MRSA (100)in vitro (ET)Ceftaroline10 (14.1)41 (57.7)20 (28.2)18 isolates were also resistant to linezolid.46
SA2017, Turkey30MRSA (100)in vitro (CB)Ceftriaxone23 (76.7)7 (23.3)No distinction between additive and indifferent effect.47
SA2017, USA2MRSA (100)in vitro (TK)Ceftaroline2 (100)Isogenic pair with one DNS strain.48
SA2019, Italy17MRSA (35.3), hVISA (29.4)in vitro (CB,TK)Ceftobiprole4 (23.5)6 (35.3)7 (41.2)49
SE16MRSE (37.5)Ceftobiprole8 (50)3 (18.8)5 (31.2)
E. faecium6VRE (83.3)Ceftobiprole1 (16.7)5 (83.3)
E. faecalis7VRE (71.4)Ceftobiprole2 (28.6)5 (71.4)
SA2019, Taiwan15VISA (40), hVISA (60)in vitro (CB, TK)Cefazolin15 (100)DNS isolates.52
15Cefmetazole13 (86.7)2 (13.3)
15Cefotaxime15 (100)
15Cefepime12 (80)3 (20)
SA2020, USA4VISA (50)in vitro (TK, PK/PD model)Cefazolin4 (100)DNS isolates.50
SA2020, USA13MRSA (69.2)in vitro (TK)Ceftaroline8 (61.5)5 (38.5)8 DNS isolates.51
E. faecalis2021, USA2VRE (100)in vitro (TK)Ceftriaxone1 (50)1 (50)33
E. faecium2Ceftriaxone2 (100)
SA2022, Taiwan10MRSA (100)in vitro (CB, TK)Ceftaroline3 (30)7 (70)53
StrainYear and countryNumber of isolatesResistance (%)In vitro (methods)/in vivo (animal and site of infection)Partner drugSynergistic effect (%)Additive effect (%)Indifferent effect (%)Antagonistic effect (%)CommentsReference
SA2005, USA2MRSA (100)in vitro (PK/PD model)Cefepime2 (100)34
SA2005, USA40MRSA (50)in vitro (ET) (TK on 1 MRSA)CefepimeET: 2 (5); TK: 1 (100)ET: 38 (95)No distinction between additive and indifferent effect.14
in vitro (ET)CeftriaxoneET: 1 (2.5)ET: 39 (97.5)
E. faecalis, E. faecium40VRE (50)in vitro (ET) (TK on 1 VSE)CefepimeET: 9 (22.5)ET: 31 (77.5); TK: 1 (100)
in vitro (ET) (TK on 2 VSE and 1 VRE)CeftriaxoneET: 18 (45)ET: 22 (55); TK: 3 (100)
SA2010, USA2MRSA (100)in vitro (PD model)Cefepime1 (50)1 (50)DNS isolates. High inoculum tested.19
SA2013, USA2hVISA (50)in vitro (PK/PD model)Ceftaroline2 (100)Two isogenic isolates, one of which mutated into a hVISA DNS strain. High inoculum tested.35
SA2014, USA3MRSA (66.7), hVISA (33.3)in vitro (biofilm model)Ceftaroline, cefazolin3 (100)Synergy was observed against all isolated for both combinations.36
SA2014, USA3VISA (100)in vitro (PK/PD model)Ceftaroline2 (66.7)1 (33.3)DNS isolates. High inoculum tested.37
E. faecium2014, USA2VRE (100)in vitro (PK/PD model)Ceftriaxone1 (50)1 (50)High inoculum tested.38
E. faecalis1Ceftriaxone1 (100)
SA2014, USA2MRSA (50)in vitro (CB, TK)Ceftaroline2 (100)39
SA2014, USA5MRSA (60); VISA (40)in vitro (TK)Ceftobiprole5 (100)40
SA2015, USA1MRSA (100)in vitro (PK/PD model)Ceftaroline1 (100)41
E. faecalis2015, USA2VRE (100)in vitro (CB, TK)Ceftaroline2 (100)25
2Cefepime1 (50)1 (50)
2Ceftriaxone1 (50)1 (50)
2Cefotaxime1 (50)1 (50)
2Cefazolin2 (100)
E. faecium2Ceftaroline2 (100)
2Cefepime1 (50)1 (50)
2Ceftriaxone1 (50)1 (50)
2Cefotaxime1 (50)1 (50)
2Cefazolin1 (50)1 (50)
E. faecium2015, USA4VRE (100)in vitro (TK)Ceftobiprole2 (50)2 (50)DNS isolates.26
E. faecalis2Ceftobiprole2 (100)
E. faecalis2015, USA1VRE (100)in vitro (PK/PD model)Ceftaroline1 (100)27
E. faecium2Ceftaroline2 (100)
Enterococcus spp.2015, USA9VRE (88.9) (2 E. faecalis, 7 E. faecium)in vitro (TK)Ceftriaxone4 (44.4)5 (55.6)DNS isolates.42
9Cefazolin2 (22.2)7 (77.8)
9Ceftaroline5 (55.6)4 (44.4)
SA2015, USA3MRSA (100)in vitro (PK/PD biofilm model)Ceftaroline3 (100)43
SA2016, USA2MRSA (100)in vitro (Hollow-fibre model)Cefazolin2 (100)Isogenic pair of DAP-susceptible and DNS isolates. High inoculum tested.44
2Ceftolozane/tazobactam1 (50)1 (50)
SA2016, USA1MRSA (100)in vivo (rabbit, IE, spleen and kidney dissemination)Ceftriaxone1 (100)Synergistic effect on spleen. In the in vivo study, equivalent human dosage of DAP 12 mg/kg was administered.45
SA2016, Spain71MRSA (100)in vitro (ET)Ceftaroline10 (14.1)41 (57.7)20 (28.2)18 isolates were also resistant to linezolid.46
SA2017, Turkey30MRSA (100)in vitro (CB)Ceftriaxone23 (76.7)7 (23.3)No distinction between additive and indifferent effect.47
SA2017, USA2MRSA (100)in vitro (TK)Ceftaroline2 (100)Isogenic pair with one DNS strain.48
SA2019, Italy17MRSA (35.3), hVISA (29.4)in vitro (CB,TK)Ceftobiprole4 (23.5)6 (35.3)7 (41.2)49
SE16MRSE (37.5)Ceftobiprole8 (50)3 (18.8)5 (31.2)
E. faecium6VRE (83.3)Ceftobiprole1 (16.7)5 (83.3)
E. faecalis7VRE (71.4)Ceftobiprole2 (28.6)5 (71.4)
SA2019, Taiwan15VISA (40), hVISA (60)in vitro (CB, TK)Cefazolin15 (100)DNS isolates.52
15Cefmetazole13 (86.7)2 (13.3)
15Cefotaxime15 (100)
15Cefepime12 (80)3 (20)
SA2020, USA4VISA (50)in vitro (TK, PK/PD model)Cefazolin4 (100)DNS isolates.50
SA2020, USA13MRSA (69.2)in vitro (TK)Ceftaroline8 (61.5)5 (38.5)8 DNS isolates.51
E. faecalis2021, USA2VRE (100)in vitro (TK)Ceftriaxone1 (50)1 (50)33
E. faecium2Ceftriaxone2 (100)
SA2022, Taiwan10MRSA (100)in vitro (CB, TK)Ceftaroline3 (30)7 (70)53

CB, chequerboard; ET, Etest; IE, infective endocarditis; DAP, daptomycin; DNS, daptomycin non-susceptible; SA, S. aureus; SE, S. epidermidis; TK, time–kill assay.

Table 3.

Studies evaluating daptomycin in combination with cephalosporins and cephalosporins + BLIs

StrainYear and countryNumber of isolatesResistance (%)In vitro (methods)/in vivo (animal and site of infection)Partner drugSynergistic effect (%)Additive effect (%)Indifferent effect (%)Antagonistic effect (%)CommentsReference
SA2005, USA2MRSA (100)in vitro (PK/PD model)Cefepime2 (100)34
SA2005, USA40MRSA (50)in vitro (ET) (TK on 1 MRSA)CefepimeET: 2 (5); TK: 1 (100)ET: 38 (95)No distinction between additive and indifferent effect.14
in vitro (ET)CeftriaxoneET: 1 (2.5)ET: 39 (97.5)
E. faecalis, E. faecium40VRE (50)in vitro (ET) (TK on 1 VSE)CefepimeET: 9 (22.5)ET: 31 (77.5); TK: 1 (100)
in vitro (ET) (TK on 2 VSE and 1 VRE)CeftriaxoneET: 18 (45)ET: 22 (55); TK: 3 (100)
SA2010, USA2MRSA (100)in vitro (PD model)Cefepime1 (50)1 (50)DNS isolates. High inoculum tested.19
SA2013, USA2hVISA (50)in vitro (PK/PD model)Ceftaroline2 (100)Two isogenic isolates, one of which mutated into a hVISA DNS strain. High inoculum tested.35
SA2014, USA3MRSA (66.7), hVISA (33.3)in vitro (biofilm model)Ceftaroline, cefazolin3 (100)Synergy was observed against all isolated for both combinations.36
SA2014, USA3VISA (100)in vitro (PK/PD model)Ceftaroline2 (66.7)1 (33.3)DNS isolates. High inoculum tested.37
E. faecium2014, USA2VRE (100)in vitro (PK/PD model)Ceftriaxone1 (50)1 (50)High inoculum tested.38
E. faecalis1Ceftriaxone1 (100)
SA2014, USA2MRSA (50)in vitro (CB, TK)Ceftaroline2 (100)39
SA2014, USA5MRSA (60); VISA (40)in vitro (TK)Ceftobiprole5 (100)40
SA2015, USA1MRSA (100)in vitro (PK/PD model)Ceftaroline1 (100)41
E. faecalis2015, USA2VRE (100)in vitro (CB, TK)Ceftaroline2 (100)25
2Cefepime1 (50)1 (50)
2Ceftriaxone1 (50)1 (50)
2Cefotaxime1 (50)1 (50)
2Cefazolin2 (100)
E. faecium2Ceftaroline2 (100)
2Cefepime1 (50)1 (50)
2Ceftriaxone1 (50)1 (50)
2Cefotaxime1 (50)1 (50)
2Cefazolin1 (50)1 (50)
E. faecium2015, USA4VRE (100)in vitro (TK)Ceftobiprole2 (50)2 (50)DNS isolates.26
E. faecalis2Ceftobiprole2 (100)
E. faecalis2015, USA1VRE (100)in vitro (PK/PD model)Ceftaroline1 (100)27
E. faecium2Ceftaroline2 (100)
Enterococcus spp.2015, USA9VRE (88.9) (2 E. faecalis, 7 E. faecium)in vitro (TK)Ceftriaxone4 (44.4)5 (55.6)DNS isolates.42
9Cefazolin2 (22.2)7 (77.8)
9Ceftaroline5 (55.6)4 (44.4)
SA2015, USA3MRSA (100)in vitro (PK/PD biofilm model)Ceftaroline3 (100)43
SA2016, USA2MRSA (100)in vitro (Hollow-fibre model)Cefazolin2 (100)Isogenic pair of DAP-susceptible and DNS isolates. High inoculum tested.44
2Ceftolozane/tazobactam1 (50)1 (50)
SA2016, USA1MRSA (100)in vivo (rabbit, IE, spleen and kidney dissemination)Ceftriaxone1 (100)Synergistic effect on spleen. In the in vivo study, equivalent human dosage of DAP 12 mg/kg was administered.45
SA2016, Spain71MRSA (100)in vitro (ET)Ceftaroline10 (14.1)41 (57.7)20 (28.2)18 isolates were also resistant to linezolid.46
SA2017, Turkey30MRSA (100)in vitro (CB)Ceftriaxone23 (76.7)7 (23.3)No distinction between additive and indifferent effect.47
SA2017, USA2MRSA (100)in vitro (TK)Ceftaroline2 (100)Isogenic pair with one DNS strain.48
SA2019, Italy17MRSA (35.3), hVISA (29.4)in vitro (CB,TK)Ceftobiprole4 (23.5)6 (35.3)7 (41.2)49
SE16MRSE (37.5)Ceftobiprole8 (50)3 (18.8)5 (31.2)
E. faecium6VRE (83.3)Ceftobiprole1 (16.7)5 (83.3)
E. faecalis7VRE (71.4)Ceftobiprole2 (28.6)5 (71.4)
SA2019, Taiwan15VISA (40), hVISA (60)in vitro (CB, TK)Cefazolin15 (100)DNS isolates.52
15Cefmetazole13 (86.7)2 (13.3)
15Cefotaxime15 (100)
15Cefepime12 (80)3 (20)
SA2020, USA4VISA (50)in vitro (TK, PK/PD model)Cefazolin4 (100)DNS isolates.50
SA2020, USA13MRSA (69.2)in vitro (TK)Ceftaroline8 (61.5)5 (38.5)8 DNS isolates.51
E. faecalis2021, USA2VRE (100)in vitro (TK)Ceftriaxone1 (50)1 (50)33
E. faecium2Ceftriaxone2 (100)
SA2022, Taiwan10MRSA (100)in vitro (CB, TK)Ceftaroline3 (30)7 (70)53
StrainYear and countryNumber of isolatesResistance (%)In vitro (methods)/in vivo (animal and site of infection)Partner drugSynergistic effect (%)Additive effect (%)Indifferent effect (%)Antagonistic effect (%)CommentsReference
SA2005, USA2MRSA (100)in vitro (PK/PD model)Cefepime2 (100)34
SA2005, USA40MRSA (50)in vitro (ET) (TK on 1 MRSA)CefepimeET: 2 (5); TK: 1 (100)ET: 38 (95)No distinction between additive and indifferent effect.14
in vitro (ET)CeftriaxoneET: 1 (2.5)ET: 39 (97.5)
E. faecalis, E. faecium40VRE (50)in vitro (ET) (TK on 1 VSE)CefepimeET: 9 (22.5)ET: 31 (77.5); TK: 1 (100)
in vitro (ET) (TK on 2 VSE and 1 VRE)CeftriaxoneET: 18 (45)ET: 22 (55); TK: 3 (100)
SA2010, USA2MRSA (100)in vitro (PD model)Cefepime1 (50)1 (50)DNS isolates. High inoculum tested.19
SA2013, USA2hVISA (50)in vitro (PK/PD model)Ceftaroline2 (100)Two isogenic isolates, one of which mutated into a hVISA DNS strain. High inoculum tested.35
SA2014, USA3MRSA (66.7), hVISA (33.3)in vitro (biofilm model)Ceftaroline, cefazolin3 (100)Synergy was observed against all isolated for both combinations.36
SA2014, USA3VISA (100)in vitro (PK/PD model)Ceftaroline2 (66.7)1 (33.3)DNS isolates. High inoculum tested.37
E. faecium2014, USA2VRE (100)in vitro (PK/PD model)Ceftriaxone1 (50)1 (50)High inoculum tested.38
E. faecalis1Ceftriaxone1 (100)
SA2014, USA2MRSA (50)in vitro (CB, TK)Ceftaroline2 (100)39
SA2014, USA5MRSA (60); VISA (40)in vitro (TK)Ceftobiprole5 (100)40
SA2015, USA1MRSA (100)in vitro (PK/PD model)Ceftaroline1 (100)41
E. faecalis2015, USA2VRE (100)in vitro (CB, TK)Ceftaroline2 (100)25
2Cefepime1 (50)1 (50)
2Ceftriaxone1 (50)1 (50)
2Cefotaxime1 (50)1 (50)
2Cefazolin2 (100)
E. faecium2Ceftaroline2 (100)
2Cefepime1 (50)1 (50)
2Ceftriaxone1 (50)1 (50)
2Cefotaxime1 (50)1 (50)
2Cefazolin1 (50)1 (50)
E. faecium2015, USA4VRE (100)in vitro (TK)Ceftobiprole2 (50)2 (50)DNS isolates.26
E. faecalis2Ceftobiprole2 (100)
E. faecalis2015, USA1VRE (100)in vitro (PK/PD model)Ceftaroline1 (100)27
E. faecium2Ceftaroline2 (100)
Enterococcus spp.2015, USA9VRE (88.9) (2 E. faecalis, 7 E. faecium)in vitro (TK)Ceftriaxone4 (44.4)5 (55.6)DNS isolates.42
9Cefazolin2 (22.2)7 (77.8)
9Ceftaroline5 (55.6)4 (44.4)
SA2015, USA3MRSA (100)in vitro (PK/PD biofilm model)Ceftaroline3 (100)43
SA2016, USA2MRSA (100)in vitro (Hollow-fibre model)Cefazolin2 (100)Isogenic pair of DAP-susceptible and DNS isolates. High inoculum tested.44
2Ceftolozane/tazobactam1 (50)1 (50)
SA2016, USA1MRSA (100)in vivo (rabbit, IE, spleen and kidney dissemination)Ceftriaxone1 (100)Synergistic effect on spleen. In the in vivo study, equivalent human dosage of DAP 12 mg/kg was administered.45
SA2016, Spain71MRSA (100)in vitro (ET)Ceftaroline10 (14.1)41 (57.7)20 (28.2)18 isolates were also resistant to linezolid.46
SA2017, Turkey30MRSA (100)in vitro (CB)Ceftriaxone23 (76.7)7 (23.3)No distinction between additive and indifferent effect.47
SA2017, USA2MRSA (100)in vitro (TK)Ceftaroline2 (100)Isogenic pair with one DNS strain.48
SA2019, Italy17MRSA (35.3), hVISA (29.4)in vitro (CB,TK)Ceftobiprole4 (23.5)6 (35.3)7 (41.2)49
SE16MRSE (37.5)Ceftobiprole8 (50)3 (18.8)5 (31.2)
E. faecium6VRE (83.3)Ceftobiprole1 (16.7)5 (83.3)
E. faecalis7VRE (71.4)Ceftobiprole2 (28.6)5 (71.4)
SA2019, Taiwan15VISA (40), hVISA (60)in vitro (CB, TK)Cefazolin15 (100)DNS isolates.52
15Cefmetazole13 (86.7)2 (13.3)
15Cefotaxime15 (100)
15Cefepime12 (80)3 (20)
SA2020, USA4VISA (50)in vitro (TK, PK/PD model)Cefazolin4 (100)DNS isolates.50
SA2020, USA13MRSA (69.2)in vitro (TK)Ceftaroline8 (61.5)5 (38.5)8 DNS isolates.51
E. faecalis2021, USA2VRE (100)in vitro (TK)Ceftriaxone1 (50)1 (50)33
E. faecium2Ceftriaxone2 (100)
SA2022, Taiwan10MRSA (100)in vitro (CB, TK)Ceftaroline3 (30)7 (70)53

CB, chequerboard; ET, Etest; IE, infective endocarditis; DAP, daptomycin; DNS, daptomycin non-susceptible; SA, S. aureus; SE, S. epidermidis; TK, time–kill assay.

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