Comment on Jugun et al.: The safety and efficacy of high-dose daptomycin combined with rifampicin for the treatment of Gram-positive osteoarticular infections

Abstract

Dear Editor, In a recent issue of International Orthopaedics, Jugun and his workmates published an article [1] entitled “The safety and efficacy of high-dose daptomycin combined with rifampicin for the treatment of Gram-positive osteoarticular infections”. In this study, the authors indicated that combined therapy with high-dose daptomycin and rifampicin was both safe and effective for the treatment of Gram-positive osteoarticular infections. The conclusion was indeed encouraging for orthopaedic surgeons providing a new method to cure Gram-positive osteoarticular infections. However, we have several opinions that we would like to communicate to the authors. Firstly, the sample size was limited (only 16 patients), which may cause bias. We suggest that more eligible patients should be included in a future study. Secondly, despite the prospective character of the study, the single-centre and the non-comparative design may reduce the persuasiveness and reliability of the conclusion. Therefore, future multi-centre and controlled studies are needed to prove the above conclusion. Thirdly, we would like to know why the authors chose the therapy strategy of intravenous daptomycin (8 mg/kg per day) and oral rifampicin (600 mg/day). Furthermore, the recruitment of patients with different types of osteoarticular infections (Table 1) may also lead to different outcomes. Fourthly, assessment of the clinical efficacy should also focus on the functional recovery of the bone and joint. Therefore, some functional evaluation scales or scores should be applied to evaluate the clinical efficacy. Thanks go to the authors for their contribution to supplying us with a new approach to treating Gram-positive osteoarticular infections.