Abstract | BACKGROUND: Increasing the dosage of daptomycin may be advantageous in severe infection by enhancing bactericidal activity and pharmacodynamics. However, clinical data on using daptomycin at doses above 6 mg/kg in Asian population are limited. METHODS: A retrospective observational cohort study of all hospitalized adult patients treated with daptomycin (> 6 mg/kg) for at least 72 hours was performed in Taiwan. RESULTS: A total of 67 patients (40 males) with a median age of 57 years received a median dose of 7.61 mg/kg (range, 6.03-11.53 mg/kg) of daptomycin for a median duration of 14 days (range, 3-53 days). Forty-one patients (61.2%) were in intensive care units (ICU). Sites of infections included complicated skin and soft tissue infections (n = 16), catheter-related bacteremia (n = 16), endocarditis (n = 11), primary bacteremia (n = 10), osteomyelitis and septic arthritis (n = 9), and miscellaneous (n = 5). The median Pitt bacteremia score among the 54 (80.6%) patients with bacteremia was 4. The most common pathogen was methicillin-resistant Staphylococcus aureus (n = 38). Fifty-nine patients (88.1%) were treated with daptomycin after glycopepetide use. Overall, 52 (77.6%) patients achieved clinical success. The all-cause mortality rate at 28 day was 35.8%. In multivariate analysis, the significant predictors of in-hospital mortality in 54 bacteremic patients were malignancies (P = 0.01) and ICU stay (P = 0.02). Adverse effects of daptomycin were generally well-tolerated, leading to discontinuation in 3 patients. Daptomycin-related creatine phosphokinase (CPK) elevations were observed in 4 patients, and all received doses > 8 mg/kg. CONCLUSIONS: Treatment with high dose daptomycin as salvage therapy was generally effective and safe in Taiwan. CPK level elevations were more frequent in patients with dose > 8 mg/kg.
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Authors | Chung-Chih Lai, Wang-Huei Sheng, Jann-Tay Wang, Aristine Cheng, Yu-Chung Chuang, Yee-Chun Chen, Shan-Chwen Chang |
Journal | BMC infectious diseases
(BMC Infect Dis)
Vol. 13
Pg. 66
(Feb 04 2013)
ISSN: 1471-2334 [Electronic] England |
PMID | 23379510
(Publication Type: Journal Article)
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Chemical References |
- Anti-Bacterial Agents
- Daptomycin
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Topics |
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Anti-Bacterial Agents
(administration & dosage, adverse effects, therapeutic use)
- Daptomycin
(administration & dosage, adverse effects, therapeutic use)
- Female
- Gram-Positive Bacteria
(classification, drug effects)
- Gram-Positive Bacterial Infections
(drug therapy)
- Humans
- Inpatients
- Male
- Middle Aged
- Retrospective Studies
- Salvage Therapy
- Sepsis
(drug therapy)
- Treatment Outcome
- Young Adult
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