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Existing guidelines are based on the theoretical premise of toxin suppression, as many strains of S. aureus produce toxins such as leukocidins (eg, Panton-Valentine leukocidin, toxic shock syndrome toxin 1, exfoliative toxins, and various enterotoxins). Many clinicians therefore believe that limiting exotoxin production release by S. aureus could reduce its virulence and improve clinical outcomes. Clindamycin, a protein synthesis inhibitor antibiotic, is commonly used for this purpose. We report the domain-specific protocol, embedded in a large adaptive, platform trial, seeking to definitively answer this question.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and Analysis<\/jats:title>\n                  <jats:p>The Staphylococcus aureus Network Adaptive Platform (SNAP) trial is a pragmatic, randomized, multicenter adaptive platform trial that aims to compare different SAB therapies, simultaneously, for 90-day mortality rates. The adjunctive treatment domain aims to test the effectiveness of adjunctive antibiotics, initially comparing clindamycin to no adjunctive antibiotic, but future adaptations may include other agents. Individuals will be randomized to receive either 5 days of adjunctive clindamycin (or lincomycin) or no adjunctive antibiotic therapy alongside standard-of-care antibiotics. Most participants with SAB (within 72\u2005hours of index blood culture and with no contraindications) will be eligible to participate in this domain. Prespecified analyses are defined in the statistical appendix to the core protocol, and domain-specific secondary analyses will be adjusted for resistance to clindamycin, disease phenotype (complicated or uncomplicated SAB) and Panton-Valentine leukocidin\u2013positive isolate.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciae289","type":"journal-article","created":{"date-parts":[[2024,5,24]],"date-time":"2024-05-24T21:19:25Z","timestamp":1716585565000},"page":"626-634","source":"Crossref","is-referenced-by-count":19,"title":["Does Adjunctive Clindamycin Have a Role in <i>Staphylococcus aureus<\/i> Bacteremia? A Protocol for the Adjunctive Treatment Domain of the <i>Staphylococcus aureus<\/i> Network Adaptive Platform (SNAP) Randomized Controlled Trial"],"prefix":"10.1093","volume":"79","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4416-4317","authenticated-orcid":false,"given":"Keerthi","family":"Anpalagan","sequence":"first","affiliation":[{"name":"Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute , Perth, Western Australia ,","place":["Australia"]},{"name":"School of Medicine, University of Western Australia , Perth, Western Australia ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravindra","family":"Dotel","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Blacktown Hospital , Westmead, New South Wales ,","place":["Australia"]},{"name":"Centre for Infectious Diseases and Microbiology, Westmead Hospital , Westmead, New South Wales 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