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Castro-Balado A, Varela-Rey I, Mejuto B, Mondelo-García C, Zarra-Ferro I, Rodríguez-Jato T, Fernández-Ferreiro A. Updated antimicrobial dosing recommendations for obese patients. Antimicrob Agents Chemother 2024; 68:e0171923. [PMID: 38526051 PMCID: PMC11064535 DOI: 10.1128/aac.01719-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
The prevalence of obesity has increased considerably in the last few decades. Pathophysiological changes in obese patients lead to pharmacokinetic (PK) and pharmacodynamic (PD) alterations that can condition the correct exposure to antimicrobials if standard dosages are used. Inadequate dosing in obese patients can lead to toxicity or therapeutic failure. In recent years, additional antimicrobial PK/PD data, extended infusion strategies, and studies in critically ill patients have made it possible to obtain data to provide a better dosage in obese patients. Despite this, it is usually difficult to find information on drug dosing in this population, which is sometimes contradictory. This is a comprehensive review of the dosing of different types of antimicrobials (antibiotics, antifungals, antivirals, and antituberculosis drugs) in obese patients, where the literature on PK and possible dosing strategies in obese adults was critically assessed.
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Affiliation(s)
- Ana Castro-Balado
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), Santiago de Compostela, Spain
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Iria Varela-Rey
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), Santiago de Compostela, Spain
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Beatriz Mejuto
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), Santiago de Compostela, Spain
| | - Cristina Mondelo-García
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), Santiago de Compostela, Spain
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Irene Zarra-Ferro
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), Santiago de Compostela, Spain
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Teresa Rodríguez-Jato
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), Santiago de Compostela, Spain
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Anxo Fernández-Ferreiro
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), Santiago de Compostela, Spain
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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2
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Codde C, Rivals F, Destere A, Fromage Y, Labriffe M, Marquet P, Benoist C, Ponthier L, Faucher JF, Woillard JB. A machine learning approach to predict daptomycin exposure from two concentrations based on Monte Carlo simulations. Antimicrob Agents Chemother 2024; 68:e0141523. [PMID: 38501807 PMCID: PMC11064575 DOI: 10.1128/aac.01415-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/23/2024] [Indexed: 03/20/2024] Open
Abstract
Daptomycin is a concentration-dependent lipopeptide antibiotic for which exposure/effect relationships have been shown. Machine learning (ML) algorithms, developed to predict the individual exposure to drugs, have shown very good performances in comparison to maximum a posteriori Bayesian estimation (MAP-BE). The aim of this work was to predict the area under the blood concentration curve (AUC) of daptomycin from two samples and a few covariates using XGBoost ML algorithm trained on Monte Carlo simulations. Five thousand one hundred fifty patients were simulated from two literature population pharmacokinetics models. Data from the first model were split into a training set (75%) and a testing set (25%). Four ML algorithms were built to learn AUC based on daptomycin blood concentration samples at pre-dose and 1 h post-dose. The XGBoost model (best ML algorithm) with the lowest root mean square error (RMSE) in a 10-fold cross-validation experiment was evaluated in both the test set and the simulations from the second population pharmacokinetic model (validation). The ML model based on the two concentrations, the differences between these concentrations, and five other covariates (sex, weight, daptomycin dose, creatinine clearance, and body temperature) yielded very good AUC estimation in the test (relative bias/RMSE = 0.43/7.69%) and validation sets (relative bias/RMSE = 4.61/6.63%). The XGBoost ML model developed allowed accurate estimation of daptomycin AUC using C0, C1h, and a few covariates and could be used for exposure estimation and dose adjustment. This ML approach can facilitate the conduct of future therapeutic drug monitoring (TDM) studies.
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Affiliation(s)
- Cyrielle Codde
- Service de Maladies Infectieuses et Tropicales, CHU Dupuytren, Limoges, France
| | - Florence Rivals
- Service de Pharmacologie, Toxicologie et Pharmacovigilance, CHU Dupuytren, Limoges, France
| | | | - Yeleen Fromage
- Service de Pharmacologie, Toxicologie et Pharmacovigilance, CHU Dupuytren, Limoges, France
| | - Marc Labriffe
- Service de Pharmacologie, Toxicologie et Pharmacovigilance, CHU Dupuytren, Limoges, France
- Inserm, Univ. Limoges, CHU Limoges, Pharmacology & Toxicology, Limoges, France
| | - Pierre Marquet
- Service de Pharmacologie, Toxicologie et Pharmacovigilance, CHU Dupuytren, Limoges, France
- Inserm, Univ. Limoges, CHU Limoges, Pharmacology & Toxicology, Limoges, France
| | - Clément Benoist
- Inserm, Univ. Limoges, CHU Limoges, Pharmacology & Toxicology, Limoges, France
| | - Laure Ponthier
- Inserm, Univ. Limoges, CHU Limoges, Pharmacology & Toxicology, Limoges, France
| | | | - Jean-Baptiste Woillard
- Service de Pharmacologie, Toxicologie et Pharmacovigilance, CHU Dupuytren, Limoges, France
- Inserm, Univ. Limoges, CHU Limoges, Pharmacology & Toxicology, Limoges, France
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3
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Contejean A, Maillard A, Canouï E, Kernéis S, Fantin B, Bouscary D, Parize P, Garcia-Vidal C, Charlier C. Advances in antibacterial treatment of adults with high-risk febrile neutropenia. J Antimicrob Chemother 2023; 78:2109-2120. [PMID: 37259598 DOI: 10.1093/jac/dkad166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND High-risk febrile neutropenia (HR-FN) is a life-threatening complication in patients with haematological malignancies or receiving myelosuppressive chemotherapy. Since the last international guidelines were published over 10 years ago, there have been major advances in the understanding and management of HR-FN, including on antibiotic pharmacokinetics and discontinuation/de-escalation strategies. OBJECTIVES Summarizing major advances in the field of antibacterial therapy in patients with HR-FN: empirical therapy, pharmacokinetics of antibiotics and antibiotic stewardship. SOURCES Narrative review based on literature review from PubMed. We focused on studies published between 2010 and 2023 about the pharmacokinetics of antimicrobials, management of antimicrobial administration, and discontinuation/de-escalation strategies. We did not address antimicrobial prophylaxis, viral or fungal infections. CONTENT Several high-quality publications have highlighted important modifications of antibiotic pharmacokinetics in HR-FN, with standard dosages exposing patients to underdosing. These recent clinical and population pharmacokinetics studies help improve management protocols with optimized initial dosing and infusion rules for β-lactams, vancomycin, daptomycin and amikacin; they highlight the potential benefits of therapeutic drug monitoring. A growing body of evidence also shows that antibiotic discontinuation/de-escalation strategies are beneficial for bacterial ecology and patients' outcome. We further discuss methods and limitations for implementation of such protocols in haematology. IMPLICATIONS We highlight recent information about the management of antibacterial therapy in HR-FN that might be considered in updated guidelines for HR-FN management.
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Affiliation(s)
- Adrien Contejean
- Service d'Hématologie, Centre Hospitalier Annecy Genevois, 1 Avenue de l'hôpital, F-74370 Epagny Metz-Tessy, France
- Équipe Mobile d'Infectiologie, AP-HP, APHP.CUP, Hôpital Cochin, F-75014 Paris, France
- Université Paris Cité, Faculté de Médecine, F-75006 Paris, France
| | - Alexis Maillard
- Équipe Mobile d'Infectiologie, AP-HP, APHP.CUP, Hôpital Cochin, F-75014 Paris, France
| | - Etienne Canouï
- Équipe Mobile d'Infectiologie, AP-HP, APHP.CUP, Hôpital Cochin, F-75014 Paris, France
| | - Solen Kernéis
- Université Paris Cité, Faculté de Médecine, F-75006 Paris, France
- Équipe de Prévention du Risque Infectieux, AP-HP, Hôpital Bichat, F-75018 Paris, France
- Université Paris Cité, INSERM, IAME, F-75018 Paris, France
| | - Bruno Fantin
- Université Paris Cité, Faculté de Médecine, F-75006 Paris, France
- Département de Médecine Interne, AP-HP, Hôpital Beaujon, F-92110, Clichy, France
| | - Didier Bouscary
- Université Paris Cité, Faculté de Médecine, F-75006 Paris, France
- Service d'Hématologie, AP-HP, APHP.CUP, Hôpital Cochin, F-75014 Paris, France
| | - Perrine Parize
- Service de Maladies Infectieuses, AP-HP, APHP.CUP, Hôpital Necker-Enfants Malades, F-75015 Paris, France
| | - Carolina Garcia-Vidal
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
- CIBERINF, Madrid, Spain
| | - Caroline Charlier
- Équipe Mobile d'Infectiologie, AP-HP, APHP.CUP, Hôpital Cochin, F-75014 Paris, France
- Université Paris Cité, Faculté de Médecine, F-75006 Paris, France
- National Reference Center Listeriosis WHO Collaborating Center, Institut Pasteur, F-75015 Paris, France
- Biology of Infection Unit, Inserm U1117 Institut Pasteur, F-75015 Paris, France
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4
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Cairns KA, Udy AA, Peel TN, Abbott IJ, Dooley MJ, Peleg AY. Therapeutics for Vancomycin-Resistant Enterococcal Bloodstream Infections. Clin Microbiol Rev 2023; 36:e0005922. [PMID: 37067406 PMCID: PMC10283489 DOI: 10.1128/cmr.00059-22] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023] Open
Abstract
Vancomycin-resistant enterococci (VRE) are common causes of bloodstream infections (BSIs) with high morbidity and mortality rates. They are pathogens of global concern with a limited treatment pipeline. Significant challenges exist in the management of VRE BSI, including drug dosing, the emergence of resistance, and the optimal treatment for persistent bacteremia and infective endocarditis. Therapeutic drug monitoring (TDM) for antimicrobial therapy is evolving for VRE-active agents; however, there are significant gaps in the literature for predicting antimicrobial efficacy for VRE BSIs. To date, TDM has the greatest evidence for predicting drug toxicity for the three main VRE-active antimicrobial agents daptomycin, linezolid, and teicoplanin. This article presents an overview of the treatment options for VRE BSIs, the role of antimicrobial dose optimization through TDM in supporting clinical infection management, and challenges and perspectives for the future.
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Affiliation(s)
- Kelly A. Cairns
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia
| | - Andrew A. Udy
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, Victoria, Australia
| | - Trisha N. Peel
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Iain J. Abbott
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Microbiology Unit, Alfred Health, Melbourne, Victoria, Australia
| | - Michael J. Dooley
- Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia
- Centre for Medicines Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Anton Y. Peleg
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Infection Program, Monash Biomedicine Discovery Institute, Department of Microbiology, Monash University, Clayton, Victoria, Australia
- Centre to Impact AMR, Monash University, Clayton, Victoria, Australia
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Wei C, Yin W, He Z, Wu B. Reporting of Drug-Induced Myopathies Associated with the Combination of Statins and Daptomycin: A Disproportionality Analysis Using the US Food and Drug Administration Adverse Event Reporting System. J Clin Med 2023; 12:jcm12103548. [PMID: 37240654 DOI: 10.3390/jcm12103548] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Myopathy is one of the most common adverse reactions of daptomycin and statins. We aimed to evaluate the muscular toxicity of the combination therapy of daptomycin and statins in a large pharmacovigilance database. METHODS This was a retrospective disproportionality analysis based on real-world data. All cases reported between the first quarter of 2004 and the fourth quarter of 2022 where daptomycin and statins were reported were gathered from the US Food and Drug Administration Adverse Event Reporting System (FAERS) database. Disproportionality analyses were conducted by estimating the proportional reporting ratios (PRRs), reporting odds ratio (ROR), and information component (IC). RESULTS A total of 971,861 eligible cases were collected from the FAERS database. Data analysis showed that rosuvastatin (ROR: 124.39, 95% CI: 87.35-178.47), atorvastatin (ROR: 68.53, 95% CI: 51.93-90.43), and simvastatin (ROR: 94.83, 95% CI: 71.12-126.46) combined with daptomycin increased the reporting frequency of myopathy. Moreover, myopathy was reported more frequently with the 3-drug combination (ROR: 598.01, 95% CI: 231.81-1542.71). For rhabdomyolysis, the frequency of reports also increased when daptomycin was combined with rosuvastatin (ROR: 156.34, 95% CI: 96.21-254.05), simvastatin (ROR: 72.65, 95% CI: 47.36-111.44), and atorvastatin (ROR: 66.31, 95% CI: 44.06-99.81). CONCLUSIONS The combination of daptomycin and statins increased the association of myopathy and rhabdomyolysis, especially with rosuvastatin, simvastatin, and atorvastatin.
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Affiliation(s)
- Chunyan Wei
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Wanhong Yin
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
- West China School of Clinical Medical College, Sichuan University, Chengdu 610041, China
| | - Zhiyao He
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Bin Wu
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu 610041, China
- West China School of Pharmacy, Sichuan University, Chengdu 610041, China
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6
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Daptomycin-Rifampin-Induced Rhabdomyolysis, Acute Renal Failure, and Hepatic Injury: A Case Report and Literature Review. Cureus 2023; 15:e36834. [PMID: 37009360 PMCID: PMC10050791 DOI: 10.7759/cureus.36834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
Daptomycin is a canonical antibiotic used very commonly in practice for its bactericidal activity against Gram-positive bacteria, including vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, bone infections, skin and soft tissue infections, meningitis, urinary tract infections, and endocarditis. Although daptomycin in conventional doses is usually well tolerated, it is paramount to be aware of the possible adverse effects. Daptomycin is reported to cause an elevation in creatine kinase levels, although frank rhabdomyolysis is rare. An even more infrequent occurrence is the simultaneous development of acute kidney injury and drug-induced liver injury with rhabdomyolysis. Daptomycin and rifampin combination are used for synergistic bactericidal action against MRSA. Still, data on the efficacy and safety of the combination is limited due to a lack of extensive studies. Herein, we present a clinical case of septic arthritis of a prosthetic knee, which resulted in bacteremia caused by methicillin-resistant Staphylococcus aureus (MRSA) and subsequently led to infective endocarditis of the aortic valve. The patient was treated with a combination of daptomycin and rifampin, complicated by the development of rhabdomyolysis, acute kidney injury, and drug-induced liver injury. This case highlights the significance of timely recognizing adverse drug effects and identifying risk factors to ensure successful patient outcomes.
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7
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Characterization of plasma daptomycin in patients with serum highly glycated albumin and obesity. J Infect Chemother 2023; 29:119-125. [PMID: 36216220 DOI: 10.1016/j.jiac.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/10/2022] [Accepted: 10/01/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Plasma daptomycin has not been fully characterized in diabetic and obese patients. This study aimed to evaluate the associations of plasma daptomycin with glycation of serum albumin and obesity. METHODS Infectious patients (n = 70) receiving intravenous daptomycin were enrolled. The plasma concentration of total and free daptomycin were determined using liquid chromatograph-tandem mass spectrometer. The associations of the plasma concentrations of daptomycin with clinical factors including serum albumin fractionations and physical status (obese including overweight, body mass index ≥ 25.0) were investigated. Daptomycin doses were adjusted using total body-weight. RESULTS The serum albumin level was positively and negatively correlated with the plasma concentration of total daptomycin and its free fraction proportion, respectively. The serum non-glycated albumin was negatively correlated with the free fraction proportion. The dose-normalized plasma concentration of total daptomycin was higher in the obese patients than in non-obese patients when the body-weight was corrected with total and adjusted values. For the dose adjustment with lean body-weight, no difference was observed in the dose-normalized plasma concentration of total daptomycin between the physical statuses. For each body-weight correction method, physical status did not affect the dose-normalized plasma concentration of free daptomycin. CONCLUSION The glycation of serum albumin and obesity did not associate with dose-normalized plasma free daptomycin. In obese patients, daptomycin dosage adjustment with total body-weight and adjusted body-weight may lead to an apparent excessive exposure resulting in overdosage compared to lean body-weight.
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8
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Samura M, Takada K, Hirose N, Kurata T, Nagumo F, Koshioka S, Ishii J, Uchida M, Inoue J, Enoki Y, Taguchi K, Tanikawa K, Matsumoto K. Incidence of elevated creatine phosphokinase between daptomycin alone and concomitant daptomycin and statins: a systematic review and meta-analysis. Br J Clin Pharmacol 2021; 88:1985-1998. [PMID: 34902879 DOI: 10.1111/bcp.15172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/24/2021] [Accepted: 12/01/2021] [Indexed: 11/28/2022] Open
Abstract
AIM The present systematic review and meta-analysis evaluated the incidence of elevated creatine phosphokinase (CPK) levels between daptomycin alone and concomitant daptomycin and statin use. METHODS We searched the PubMed, Web of Sciences, Cochrane Library, and ClinicalTrials.gov databases. We analysed the incidence of elevated CPK between daptomycin alone and concomitant daptomycin and statins among studies defining CPK elevation as levels ≥ the upper limit of normal (ULN) or ≥ 5 times ULN. We also analysed the incidence of rhabdomyolysis between the groups. We then calculated the odds ratios (ORs) and 95% confidence intervals (CIs) based on the included studies. RESULTS Comparing CPK elevation defined as CPK levels ≥ ULN, a significantly higher incidence of CPK elevation was observed with concomitant daptomycin and statin use than with daptomycin alone (OR=2.55, 95% CI 1.78-3.64, p<0.00001, I2 =0%). Likewise, when CPK elevation was defined as CPK levels ≥ 5 times ULN, a significantly higher incidence of CPK elevation was detected with concomitant daptomycin and statin use than with daptomycin alone (OR = 1.89, 95% CI 1.06-3.35, p=0.03, I2 =48%). The incidence of rhabdomyolysis was significantly higher following concomitant daptomycin and statin use than with daptomycin alone (OR = 11.60, 95% CI 1.81-74.37, p=0.01, I2 =0%). CONCLUSIONS The combined use of daptomycin and statins were significant risk factors for the incidence of CPK elevation defined as levels ≥ ULN or ≥ 5 times ULN and rhabdomyolysis.
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Affiliation(s)
- Masaru Samura
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan.,Department of Pharmacy, Yokohama General Hospital, Yokohama, Kanagawa, Japan
| | - Keisuke Takada
- Department of Pharmacy, Yokohama General Hospital, Yokohama, Kanagawa, Japan
| | - Naoki Hirose
- Department of Pharmacy, Yokohama General Hospital, Yokohama, Kanagawa, Japan
| | - Takenori Kurata
- Department of Pharmacy, Yokohama General Hospital, Yokohama, Kanagawa, Japan
| | - Fumio Nagumo
- Department of Pharmacy, Yokohama General Hospital, Yokohama, Kanagawa, Japan
| | - Sakura Koshioka
- Department of Pharmacy, Yokohama General Hospital, Yokohama, Kanagawa, Japan
| | - Junichi Ishii
- Department of Pharmacy, Yokohama General Hospital, Yokohama, Kanagawa, Japan
| | - Masaki Uchida
- Department of Pharmacy, Yokohama General Hospital, Yokohama, Kanagawa, Japan
| | - Junki Inoue
- Department of Pharmacy, Yokohama General Hospital, Yokohama, Kanagawa, Japan
| | - Yuki Enoki
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Kazuaki Taguchi
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Koji Tanikawa
- Department of Pharmacy, Yokohama General Hospital, Yokohama, Kanagawa, Japan
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
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Imai S, Kashiwagi H, Sato Y, Miyai T, Sugawara M, Takekuma Y. Factors affecting creatine phosphokinase elevation during daptomycin therapy using a combination of machine learning and conventional methods. Br J Clin Pharmacol 2021; 88:1211-1222. [PMID: 34436795 DOI: 10.1111/bcp.15063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/10/2021] [Accepted: 08/16/2021] [Indexed: 01/04/2023] Open
Abstract
AIMS Musculoskeletal toxicity is a typical side effect of daptomycin (DAP). However, the risk factors have not been well established. Here, we aimed to identify independent factors affecting DAP-induced musculoskeletal toxicity using a combination of machine learning and conventional statistical methods. METHODS A population-based, retrospective, observational cohort study was conducted using the Japanese electronic medical record database. Patients who received DAP between October 2011 and December 2020 were enrolled. Two definitions of musculoskeletal toxicity were employed: (1) elevation of creatine phosphokinase (CPK) value more than twice from baseline and >200 IU/L, and (2) >1000 IU/L. First, multiple logistic regression analyses (a conventional statistical method) were performed to identify independent factors affecting CPK elevation. Then, decision tree analyses, a machine learning method, were performed to detect combinations of factors that change CPK elevation risk. RESULTS Of the 2970 patients who received DAP, 706 were included. Elevation of CPK values >200 IU/L and >1000 IU/L occurred in 83 (11.8%) and 17 (2.41%) patients, respectively. In multiple logistic regression analysis, baseline CPK value and concomitant use of hydrophobic statins were commonly extracted as independent factors affecting each CPK elevation, but concomitant use of hydrophilic statins was not. In decision tree analysis, patients who received hydrophobic statins and had high baseline CPK values were classified into the high-risk group. CONCLUSION Our novel approach revealed new risk factors for CPK elevation. Our findings suggest that high-risk patients require frequent CPK monitoring.
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Affiliation(s)
- Shungo Imai
- Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan
| | - Hitoshi Kashiwagi
- Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan
| | - Yuki Sato
- Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan
| | - Takayuki Miyai
- Graduate School of Life Science, Hokkaido University, Sapporo, Japan
| | - Mitsuru Sugawara
- Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan.,Department of Pharmacy, Hokkaido University Hospital, Sapporo, Japan.,Global Station for Biosurfaces and Drug Discovery, Hokkaido University, Sapporo, Japan
| | - Yoh Takekuma
- Department of Pharmacy, Hokkaido University Hospital, Sapporo, Japan
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10
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Jones TW, Jun AH, Michal JL, Olney WJ. High-Dose Daptomycin and Clinical Applications. Ann Pharmacother 2021; 55:1363-1378. [PMID: 33535792 DOI: 10.1177/1060028021991943] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate evidence for high-dose daptomycin (doses ≥ 8 mg/kg/d). DATA SOURCES A PubMed/MEDLINE literature search was performed (January 2000 to December 2020) using the search terms daptomycin, high dose, and dosing. Review article references and society guidelines were reviewed. STUDY SELECTION AND DATA EXTRACTION Clinical trials, observational studies, retrospective studies, meta-analyses, and systematic reviews reporting on high-dose daptomycin were included. DATA SYNTHESIS Experimentally, daptomycin outperforms other antimicrobials for high inoculum and biofilm-associated infections. Clinically, high-dose daptomycin is supported as salvage and first-line therapy for endocarditis and bacteremia, primarily when caused by methicillin-resistant Staphylococcus aureus (when vancomycin minimum inhibitory concentration is >1 mg/L) and Enterococcus. High-dose daptomycin appears effective for osteomyelitis and central nervous system infections, although comparative studies are lacking. High dosing in renal replacement therapy requires considering clearance modality to achieve exposures like normal renal function. Weight-based dosing in obesity draws concern for elevated exposures, although high doses have not been evaluated kinetically in obesity. Some data show benefits of high doses in overweight populations. Burn patients clear daptomycin more rapidly, and high doses may only achieve drug exposures similar to standard doses (6 mg/kg). RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE This review analyzes the efficacy and safety of high-dose daptomycin in serious gram-positive infections. Discussion of specific infectious etiologies and patient populations should encourage clinicians to evaluate their daptomycin dosing standards. CONCLUSIONS The efficacy of high-dose daptomycin and limited safety concerns encourage clinicians to consider high-dose daptomycin more liberally in severe gram-positive infections.
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Gregoire N, Chauzy A, Buyck J, Rammaert B, Couet W, Marchand S. Clinical Pharmacokinetics of Daptomycin. Clin Pharmacokinet 2020; 60:271-281. [PMID: 33313994 DOI: 10.1007/s40262-020-00968-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 11/26/2022]
Abstract
Due to the low level of resistance observed with daptomycin, this antibiotic has an important place in the treatment of severe Gram-positive infections. It is the first-in-class of the group of calcium-dependent, membrane-binding lipopeptides, and is a cyclic peptide constituted of 13 amino acids and an n-decanoyl fatty acid chain. The antibacterial action of daptomycin requires its complexation with calcium. Daptomycin is not absorbed from the gastrointestinal tract and needs to be administered parenterally. The distribution of daptomycin is limited (volume of distribution of 0.1 L/kg in healthy volunteers) due to its negative charge at physiological pH and its high binding to plasma proteins (about 90%). Its elimination is mainly renal, with about 50% of the dose excreted unchanged in the urine, justifying dosage adjustment for patients with renal insufficiency. The pharmacokinetics of daptomycin are altered under certain pathophysiological conditions, resulting in high interindividual variability. As a result, therapeutic drug monitoring of daptomycin may be of interest for certain patients, such as intensive care unit patients, patients with renal or hepatic insufficiency, dialysis patients, obese patients, or children. A target for the ratio of the area under the curve to the minimum inhibitory concentration > 666 is usually recommended for clinical efficacy, whereas in order to limit the risk of undesirable muscular effects the residual concentration should not exceed 24.3 mg/L.
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Affiliation(s)
- Nicolas Gregoire
- INSERM, U1070, UFR de Médecine Pharmacie, Université de Poitiers, 1 rue Georges Bonnet, TSA 51106, 86073, Poitiers Cedex 9, France
- Laboratoire de Toxicologie-Pharmacocinétique, CHU of Poitiers, 2 rue de la Miletrie, 86000, Poitiers, France
| | - Alexia Chauzy
- INSERM, U1070, UFR de Médecine Pharmacie, Université de Poitiers, 1 rue Georges Bonnet, TSA 51106, 86073, Poitiers Cedex 9, France
| | - Julien Buyck
- INSERM, U1070, UFR de Médecine Pharmacie, Université de Poitiers, 1 rue Georges Bonnet, TSA 51106, 86073, Poitiers Cedex 9, France
| | - Blandine Rammaert
- INSERM, U1070, UFR de Médecine Pharmacie, Université de Poitiers, 1 rue Georges Bonnet, TSA 51106, 86073, Poitiers Cedex 9, France
- Service de maladies infectieuses et tropicales, CHU of Poitiers, 2 rue de la Miletrie, 86000, Poitiers, France
| | - William Couet
- INSERM, U1070, UFR de Médecine Pharmacie, Université de Poitiers, 1 rue Georges Bonnet, TSA 51106, 86073, Poitiers Cedex 9, France.
- Laboratoire de Toxicologie-Pharmacocinétique, CHU of Poitiers, 2 rue de la Miletrie, 86000, Poitiers, France.
| | - Sandrine Marchand
- INSERM, U1070, UFR de Médecine Pharmacie, Université de Poitiers, 1 rue Georges Bonnet, TSA 51106, 86073, Poitiers Cedex 9, France
- Laboratoire de Toxicologie-Pharmacocinétique, CHU of Poitiers, 2 rue de la Miletrie, 86000, Poitiers, France
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12
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Durmuş M, Bahçecioğlu ÖF, Gök S. Daptomycin in combination with rosuvastatin induced blood creatine phosphokinase elevation. Eur J Hosp Pharm 2020; 28:234-236. [PMID: 34162676 DOI: 10.1136/ejhpharm-2020-002218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 11/04/2022] Open
Abstract
We present the case of a 73-year-old male patient who was hospitalised with infective endocarditis, and report an elevation in his blood creatine phosphokinase (CPK) after receiving daptomycin and rosuvastatin therapy concomitantly. His previous home-scheduled medications included apixaban, ivabradine, metformin, rosuvastatin 20 mg, ginkgo biloba and trimetazidine, and he continued to receive these medications at the hospital. After three sets of blood cultures were taken, empirical treatment was started with vancomycin and gentamicin. On the eighth day of treatment, daptomycin and ampicillin-sulbactam were initiated due to ampicillin-resistant Enterococcus faecalis growth in the patient's blood culture. Daptomycin and rosuvastatin were discontinued on the 23rd day of treatment because of blood CPK elevation (2416 U/L) and linezolid was started instead of daptomycin. Six days after discontinuation of daptomycin and rosuvastatin, the CPK concentrations returned to normal range.
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Affiliation(s)
| | | | - Selim Gök
- Clinical pharmacy, Inonu University, Malatya, Turkey
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13
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Hammond DA, Rech MA. How‐to guide for effectively performing and coordinating multicenter observational research as a clinical pharmacist. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Drayton A. Hammond
- Department of Pharmacy Rush University Medical Center Chicago Illinois
- Department of Internal Medicine Rush Medical College Chicago Illinois
| | - Megan A. Rech
- Department of Pharmacy Loyola University Medical Center Maywood Illinois
- Department of Emergency Medicine Loyola University Medical Center Maywood Illinois
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14
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Ando M, Nishioka H, Nakasako S, Kuramoto E, Ikemura M, Kamei H, Sono Y, Sugioka N, Fukushima S, Hashida T. Observational retrospective single-centre study in Japan to assess the clinical significance of serum daptomycin levels in creatinine phosphokinase elevation. J Clin Pharm Ther 2019; 45:290-297. [PMID: 31696963 DOI: 10.1111/jcpt.13061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/10/2019] [Accepted: 09/20/2019] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Daptomycin-induced creatinine phosphokinase (CPK) elevation is reported to be associated with its trough level (Ctrough ; breakpoint of 24.3 μg/mL). However, even with high-dose treatment (ie, > 8 mg/kg), the safety of daptomycin treatment is widely demonstrated with low or no significant incidence of CPK elevation or other adverse effects, despite the possibility of Ctrough above 24.3 μg/mL. Therefore, we questioned the clinical significance of Ctrough levels of 24.3 μg/mL. In this study, we retrospectively evaluated the significance of Ctrough in the clinical setting, in addition to completing a retrospective safety assessment of daptomycin utilizing electronic health records. METHODS Patients who had received daptomycin treatment for > 4 days from July 2011 to June 2015 were enrolled. Serum daptomycin levels, including Ctrough and peak (Cpeak ), were measured by high-performance liquid chromatography equipped with a photodiode array. To evaluate the safety, patients' characteristics and relevant laboratory test values were reviewed retrospectively using an electronic medical record system. RESULTS AND DISCUSSION A total of 52 therapeutic cases for 46 patients were identified; of these, Ctrough and Cpeak levels were measured in 27 and 28 cases, respectively, and 6 patients received multiple courses of daptomycin treatment. The median age of the 52 patients was 68 years (range: 19-88 years), and 14 patients initially had an estimated creatinine clearance of less than 30 mL/min. Seven cases indicated a Ctrough of above 24.3 μg/mL; however, none of these presented CPK elevation, which meets with the study definition for abnormality. Furthermore, of the two patients with abnormal CPK elevations, only one patient had a measured Ctrough (of 10.9 μg/mL). Their CPK abnormalities were temporal and did not result in treatment discontinuation. The other four patients discontinued daptomycin treatment due to suspicions of adverse effects. Of the discontinued patients, two had measured Ctrough levels; these were 8.6 and 8.1 μg/mL. All patients with abnormal CPK elevation or treatment discontinuation exhibited Ctrough levels lower than 24.3 μg/mL. In this study, two patients receiving high-dose daptomycin (ie, 9.4 and 10.0 mg/kg) had observed Ctrough levels similar to patients who received doses of daptomycin < 9 mg/kg. WHAT IS NEW AND CONCLUSIONS The safety of daptomycin treatment was suggested in this study. Ctrough level of 24.3 μg/mL was not suggested as a significant clinical index for the incidence of CPK elevation, adverse effects or treatment discontinuation. Thus, acceptable tolerability towards higher Ctrough levels than 24.3 μg/mL was also suggested, though further studies are required. On the other hand, low levels of daptomycin in blood were unexpectedly observed in two cases, despite the high-dose treatments. Accordingly, the monitoring of serum daptomycin levels may also be useful to assess cases in which subtherapeutic levels were achieved.
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Affiliation(s)
- Motozumi Ando
- Faculty of Pharmaceutical Sciences, Kobe Gakuin University, Kobe, Japan
| | - Hiroaki Nishioka
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shinji Nakasako
- Department of Pharmacy, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Eriko Kuramoto
- Department of Pharmacy, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Mai Ikemura
- Faculty of Pharmaceutical Sciences, Kobe Gakuin University, Kobe, Japan
| | - Hiroki Kamei
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yumi Sono
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Nobuyuki Sugioka
- Faculty of Pharmaceutical Sciences, Kobe Gakuin University, Kobe, Japan
| | - Shoji Fukushima
- Faculty of Pharmaceutical Sciences, Kobe Gakuin University, Kobe, Japan
| | - Tohru Hashida
- Department of Pharmacy, Kobe City Medical Center General Hospital, Kobe, Japan
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15
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Fox AN, Smith WJ, Kupiec KE, Harding SJ, Resman-Targoff BH, Neely SB, White BP, Owens RE. Daptomycin dosing in obese patients: analysis of the use of adjusted body weight versus actual body weight. Ther Adv Infect Dis 2019; 6:2049936118820230. [PMID: 30728962 PMCID: PMC6354309 DOI: 10.1177/2049936118820230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 11/27/2018] [Indexed: 12/26/2022] Open
Abstract
Background Food and Drug Administration-approved daptomycin dosing uses actual body weight, despite limited dosing information for obese patients. Studies report alterations in daptomycin pharmacokinetics and creatine phosphokinase elevations associated with higher weight-based doses required for obese patients. Limited information regarding clinical outcomes with alternative daptomycin dosing strategies in obesity exists. Objective This study evaluates equivalency of clinical and safety outcomes in obese patients with daptomycin dosed on adjusted body weight versus a historical cohort using actual body weight. Methods This retrospective, single center study compared equivalency of outcomes with two one-sided tests in patients with body mass index ⩾30 kg/m2 who received daptomycin dosed on actual body weight versus adjusted body weight. The primary outcome was clinical failure. Secondary outcomes included 90-day readmission and 90-day mortality. A combined safety endpoint included creatine phosphokinase elevation, patient-reported myopathy, and rhabdomyolysis. Results A total of 667 patients were screened for inclusion; 101 patients were analyzed with 50 in the actual body weight cohort and 51 in the adjusted body weight cohort. The two regimens were statistically equivalent for clinical failure (2% actual body weight versus 4% adjusted body weight; p < 0.001 for equivalency). The two regimens were also statistically equivalent for 90-day mortality (6% actual body weight versus 4% adjusted body weight; p = 0.0014 for equivalency). Limitations include single center, retrospective design, and sample size. Daptomycin dosing intensified throughout the study period. Conclusion The two daptomycin dosing cohorts were statistically equivalent for both clinical failure and 90-day mortality. More data are needed to assess outcomes with higher (⩾8 mg/kg/day) daptomycin doses in this patient population.
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Affiliation(s)
- Ashley N Fox
- Department of Pharmacy: Clinical and Administrative Sciences, College of Pharmacy, The University of Oklahoma, Oklahoma City, OK, USA
| | - Winter J Smith
- Department of Clinical Sciences, The Ben and Maytee Fisch College of Pharmacy, The University of Texas at Tyler, Tyler, TX, USA
| | - Katherine E Kupiec
- Department of Clinical Pharmacy, OU Medical Center, Oklahoma City, OK, USA
| | | | - Beth H Resman-Targoff
- Department of Pharmacy: Clinical and Administrative Sciences, College of Pharmacy, The University of Oklahoma, Oklahoma City, OK, USA
| | - Stephen B Neely
- Office of Instructional Science and Assessment, College of Pharmacy, The University of Oklahoma, Oklahoma City, OK, USA
| | - Bryan P White
- Department of Clinical Pharmacy, OU Medical Center, Oklahoma City, OK, USA
| | - Ryan E Owens
- Department of Pharmacy Practice, Wingate University School of Pharmacy, Hendersonville, NC, USA
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16
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Kido K, Oyen AA, Beckmann MA, Brouse SD. Musculoskeletal toxicities in patients receiving concomitant statin and daptomycin therapy. Am J Health Syst Pharm 2019; 76:206-210. [DOI: 10.1093/ajhp/zxy036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Kazuhiko Kido
- College of Pharmacy Allied Health Professions, South Dakota State University, Sioux Falls, SD
- Department of Pharmacy Practice, Avera McKennan Hospital, Sioux Falls, SD
| | - Austin A Oyen
- College of Pharmacy Allied Health Professions, South Dakota State University, Sioux Falls, SD
| | - Morgan A Beckmann
- College of Pharmacy Allied Health Professions, South Dakota State University, Sioux Falls, SD
| | - Sara D Brouse
- School of Pharmacy, Texas Tech University Health Sciences Center, Abilene, TX
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17
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Dare RK, Tewell C, Harris B, Wright PW, Van Driest SL, Farber-Eger E, Nelson GE, Talbot TR. Effect of Statin Coadministration on the Risk of Daptomycin-Associated Myopathy. Clin Infect Dis 2018; 67:1356-1363. [PMID: 29668884 PMCID: PMC6186852 DOI: 10.1093/cid/ciy287] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 04/14/2018] [Indexed: 01/13/2023] Open
Abstract
Background Daptomycin-associated myopathy has been identified in 2%-14% of patients, and rhabdomyolysis is a known adverse effect. Although risk factors for daptomycin-associated myopathy are poorly defined, creatine phosphokinase (CPK) monitoring and temporary discontinuation of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, or "statins," has been recommended. Methods We conducted a single-center, retrospective, matched case-control risk factor analysis in adult and pediatric patients from 2004 to 2015. Patients in whom myopathy (defined as CPK values above the upper limit of normal) developed during daptomycin treatment were matched 1:1 to no-myopathy controls with at least the same duration of therapy. Risk factors independently associated with myopathy were determined using multivariable conditional logistic regression. Secondary analysis was performed in patients with rhabdomyolysis, defined as CPK values ≥10 times the upper limit of normal. Results Of 3042 patients reviewed, 128 (4.2%) were identified as having daptomycin-associated myopathy, 25 (0.8%) of whom had rhabdomyolysis; 121 (95%) of the 128 were adults, and the mean duration of therapy before CPK elevation was 16.7 days (range, 1-58 days). In multivariate analysis, deep abscess treatment (odds ratio, 2.80; P = .03), antihistamine coadministration (3.50; P = .03), and statin coadministration (2.60; P = .03) were independent risk factors for myopathy. Obesity (odds ratio, 3.28; P = .03) and statin coadministration (4.67; P = .03) were found to be independent risk factors for rhabdomyolysis, and older age was associated with reduced risk (0.97; P = .05). Conclusions Statin coadministration with daptomycin was independently associated with myopathy and rhabdomyolysis. This is the first study to provide strong evidence supporting this association. During coadministration, we recommend twice-weekly CPK monitoring and consideration of withholding statins.
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Affiliation(s)
- Ryan K Dare
- Division of Infectious Diseases, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock
| | | | - Bryan Harris
- Division of Infectious Diseases, Department of Medicine, Nashville, Tennessee
| | - Patty W Wright
- Division of Infectious Diseases, Department of Medicine, Nashville, Tennessee
| | - Sara L Van Driest
- Division of General Pediatrics, Department of Pediatrics, Nashville, Tennessee
- Division of Clinical Pharmacology, Department of Medicine, Nashville, Tennessee
| | - Eric Farber-Eger
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - George E Nelson
- Division of Infectious Diseases, Department of Medicine, Nashville, Tennessee
| | - Thomas R Talbot
- Division of Infectious Diseases, Department of Medicine, Nashville, Tennessee
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18
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Butterfield-Cowper JM, Lodise TP, Pai MP. A Fixed versus Weight-Based Dosing Strategy of Daptomycin May Improve Safety in Obese Adults. Pharmacotherapy 2018; 38:981-985. [DOI: 10.1002/phar.2157] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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Tai CH, Shao CH, Chen CY, Lin SW, Wu CC. Safety of high-dose daptomycin in patients with severe renal impairment. Ther Clin Risk Manag 2018; 14:493-499. [PMID: 29559785 PMCID: PMC5856061 DOI: 10.2147/tcrm.s159587] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Treatment options are limited for infections due to multidrug-resistant Gram-positive pathogens. Daptomycin is a lipopeptide antibiotic with concentration-dependent killing characteristic and dose-dependent post-antibiotic effect. To achieve optimized pharma-codynamic effect, some experts advocated using a high dose of daptomycin (≥9 mg/kg) for severe infections. However, the safety of high-dose therapy in patients with renal impairment remains unknown. This study was aimed to evaluate the safety of daptomycin in patients with severe renal impairment. Methods This was a retrospective study performed by reviewing electronic medical records. Patients with severe renal impairment who were treated with daptomycin in a tertiary teaching hospital between January 1, 2013, and June 30, 2016, were included for evaluation. The incidence rates of creatine kinase (CK) elevation between high-dose (≥9 mg/kg) and standard-dose (<9 mg/kg) groups were compared. Results Overall, 164 patients met the inclusion criteria, and 114 (69.5%) of them were on renal replacement therapy. Vancomycin-resistant enterococci were the most common pathogens (61.3%) of the patients with documented pathogens. The treatment success rate was 51.6% in the 91 patients with bacteremia. The average dose of daptomycin was 8.0±2.3 mg/kg, and 37 (22.6%) patients received ≥9 mg/kg. CK levels were followed in 108 (65.9%) patients. Significantly higher incidence of CK elevation was found in the high-dose group compared with that in the standard-dose group (10.8% vs 1.6%, P<0.05). Moreover, patients with elevated CK received a higher dose of daptomycin than those without (9.3±1.2 vs 7.9±2.3 mg/kg, P<0.05). There was no significant difference in the rate of CK elevation between patients treated with different dosing frequency or with the concurrent use of statins, fibrate, or colchicine. Conclusions In patients with severe renal impairment, high-dose (≥9 mg/kg) daptomycin therapy may result in a significantly higher incidence of CK elevation. More frequent CK monitoring is warranted to avoid potential harm in this population.
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Affiliation(s)
- Chih-Hsun Tai
- Department of Pharmacy, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-Hao Shao
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chen-You Chen
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shu-Wen Lin
- Department of Pharmacy, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Chih Wu
- Department of Pharmacy, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
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20
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Meng L, Mui E, Holubar MK, Deresinski SC. Comprehensive Guidance for Antibiotic Dosing in Obese Adults. Pharmacotherapy 2017; 37:1415-1431. [DOI: 10.1002/phar.2023] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Lina Meng
- Department of Pharmacy; Stanford Health Care; Stanford California
- Stanford Antimicrobial Safety and Sustainability Program; Stanford Health Care; Stanford California
| | - Emily Mui
- Department of Pharmacy; Stanford Health Care; Stanford California
- Stanford Antimicrobial Safety and Sustainability Program; Stanford Health Care; Stanford California
| | - Marisa K. Holubar
- Stanford Antimicrobial Safety and Sustainability Program; Stanford Health Care; Stanford California
- Division of Infectious Diseases and Geographic Medicine; Stanford University School of Medicine; Stanford California
| | - Stan C. Deresinski
- Stanford Antimicrobial Safety and Sustainability Program; Stanford Health Care; Stanford California
- Division of Infectious Diseases and Geographic Medicine; Stanford University School of Medicine; Stanford California
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21
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Russell JM, Nick-Dart RL, Nornhold BD. Development of a pharmacist-driven protocol for automatic medication dosage adjustments in obese patients. Am J Health Syst Pharm 2016; 72:1656-63. [PMID: 26386107 DOI: 10.2146/ajhp140315] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE A hospital protocol utilizing automatic dosage adjustments and pharmacist consultations to optimize the use of certain medications in obese patients is described. SUMMARY After conducting a literature search focused on medication dosing in obese patients, pharmacists at a large community hospital developed a list of commonly ordered medications appropriate for inclusion in a pharmacy-driven institutional protocol for automatic medication dosage adjustment in adult patients with obesity. Evidence-based recommendations on initial dosing of eight antimicrobials and two anticoagulant agents according to weight and renal function were formulated. Under the protocol, pharmacists receive electronic alerts regarding protocol-eligible patients during initial order verification and automatically adjust medication dosages as appropriate. For patients prescribed anticoagulants at specified dosage levels, clinical pharmacists consult with prescribers to help ensure safe and effective initial and ongoing therapy. Multidisciplinary educational initiatives were conducted prior to protocol implementation. During two designated three-week postimplementation data collection periods, pharmacists received a total of 372 protocol-eligible medication orders. Pharmacists adjusted a total of 149 dosages and verified an additional 183 dosages consistent with the protocol as originally ordered. Clinical pharmacy consults were completed for 10-15% of patients, with laboratory monitoring ordered in 25-30% of those cases (all patients were found to have appropriate test values). There have been no documented adverse drug reactions in patients whose medication dosages were adjusted per protocol. CONCLUSION Pharmacists implemented weight- and renal function-based dosage adjustments for obese patients in 40% of evaluated protocol-eligible cases to achieve 89% compliance with the protocol. Heparin and cefazolin were the medications most likely to require obesity-related dosage adjustments.
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Affiliation(s)
- Justine M Russell
- Justine M. Russell, Pharm. D., BCPS, is Clinical Pharmacy Specialist, Emergency Department; Rebecca L. Nick-Dart, Pharm. D., BCPS, is Clinical Pharmacy Specialist, Internal Medicine; and Brandon D. Nornhold, Pharm. D., BCPS, is Clinical Pharmacy Specialist, Critical Care, Saint Vincent Hospital, Erie, PA.
| | - Rebecca L Nick-Dart
- Justine M. Russell, Pharm. D., BCPS, is Clinical Pharmacy Specialist, Emergency Department; Rebecca L. Nick-Dart, Pharm. D., BCPS, is Clinical Pharmacy Specialist, Internal Medicine; and Brandon D. Nornhold, Pharm. D., BCPS, is Clinical Pharmacy Specialist, Critical Care, Saint Vincent Hospital, Erie, PA
| | - Brandon D Nornhold
- Justine M. Russell, Pharm. D., BCPS, is Clinical Pharmacy Specialist, Emergency Department; Rebecca L. Nick-Dart, Pharm. D., BCPS, is Clinical Pharmacy Specialist, Internal Medicine; and Brandon D. Nornhold, Pharm. D., BCPS, is Clinical Pharmacy Specialist, Critical Care, Saint Vincent Hospital, Erie, PA
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22
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Dhurandhar NV, Bailey D, Thomas D. Interaction of obesity and infections. Obes Rev 2015; 16:1017-29. [PMID: 26354800 DOI: 10.1111/obr.12320] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 07/20/2015] [Accepted: 08/03/2015] [Indexed: 12/11/2022]
Abstract
There is evidence that certain infections may induce obesity. Obese persons may also have more severe infections and have compromised response to therapies. The objective of this study is to review the available literature identifying infections that potentially contribute to greater body mass index (BMI) and differential responses of overweight and obese persons to infections. A systematic literature review of human studies examining associations between infections and weight gain, differential susceptibility, severity, and response to prevention and treatment of infection according to BMI status (January 1980-July 2014) was conducted. Three hundred and forty-three studies were eligible for inclusion. Evidence indicated that viral infection by human adenovirus Ad36 and antibiotic eradication of Helicobacter pylori were followed by weight gain. People who were overweight or obese had higher susceptibility to developing post-surgical infections, H1N1 influenza and periodontal disease. More severe infections tended to be present in people with a larger BMI. People with a higher BMI had a reduced response to vaccinations and antimicrobial drugs. Higher doses of antibiotics were more effective in obese patients. Infections may influence BMI, and BMI status may influence response to certain infections, as well as to preventive and treatment measures. These observations have potential clinical implications.
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Affiliation(s)
- N V Dhurandhar
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, USA
| | - D Bailey
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, USA
| | - D Thomas
- Center for Quantitative Obesity Research, Department of Mathematical Sciences, Montclair State University, Montclair, NJ, USA
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23
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Bland CM, Bookstaver PB, Lu ZK, Dunn BL, Rumley KF. Musculoskeletal safety outcomes of patients receiving daptomycin with HMG-CoA reductase inhibitors. Antimicrob Agents Chemother 2014; 58:5726-31. [PMID: 25022580 PMCID: PMC4187944 DOI: 10.1128/aac.02910-14] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 07/08/2014] [Indexed: 12/31/2022] Open
Abstract
Daptomycin, a cyclic lipopeptide antibiotic, and 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) are commonly administered in the inpatient setting and are associated with creatine phosphokinase (CPK) elevations, myalgias, and muscle weakness. Safety data for coadministration of daptomycin with statins are limited. To determine the safety of coadministration of daptomycin with statin therapy, a multicenter, retrospective, observational study was performed at 13 institutions in the Southeastern United States. Forty-nine adult patients receiving statins concurrently with daptomycin were compared with 171 patients receiving daptomycin without statin therapy. Detailed information, including treatment indication and duration, infecting pathogen, baseline and subsequent CPK levels, and presence of myalgias or muscle complaints, was collected. Myalgias were noted in 3/49 (6.1%) patients receiving combination therapy compared with 5/171 (2.9%) of patients receiving daptomycin alone (P = 0.38). CPK elevations of >1,000 U/liter occurred in 5/49 (10.2%) patients receiving combination therapy compared to 9/171 (5.3%) patients receiving daptomycin alone (P = 0.32). Two of five patients experiencing CPK elevations of >1,000 U/liter in the combination group had symptoms of myopathy. Three patients (6.1%) discontinued therapy due to CPK elevations with concurrent myalgias in the combination group versus 6 patients (3.5%) in the daptomycin-alone group (P = 0.42). CPK levels and myalgias reversed upon discontinuation of daptomycin therapy. Overall musculoskeletal toxicity was numerically higher in the combination group but this result was not statistically significant. Further prospective study is warranted in a larger population.
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Affiliation(s)
- Christopher M Bland
- Department of Clinical Pharmacy, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia, USA Department of Clinical Pharmacy & Outcomes Sciences, South Carolina College of Pharmacy at the University of South Carolina, Columbia, South Carolina, USA
| | - P Brandon Bookstaver
- Department of Clinical Pharmacy & Outcomes Sciences, South Carolina College of Pharmacy at the University of South Carolina, Columbia, South Carolina, USA
| | - Z Kevin Lu
- Department of Clinical Pharmacy & Outcomes Sciences, South Carolina College of Pharmacy at the University of South Carolina, Columbia, South Carolina, USA
| | - Brianne L Dunn
- Department of Clinical Pharmacy & Outcomes Sciences, South Carolina College of Pharmacy at the University of South Carolina, Columbia, South Carolina, USA
| | - Kathey Fulton Rumley
- Department of Internal Medicine, Vidant Medical Center, Greenville, North Carolina, USA Campbell University School of Pharmacy, Buies Creek, North Carolina, USA
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Polso AK, Lassiter JL, Nagel JL. Impact of hospital guideline for weight-based antimicrobial dosing in morbidly obese adults and comprehensive literature review. J Clin Pharm Ther 2014; 39:584-608. [PMID: 25203631 DOI: 10.1111/jcpt.12200] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 08/07/2014] [Indexed: 12/19/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Obesity is a significant burden on the healthcare system in the United States, and determining the appropriate antimicrobial dosing regimen in morbidly obese patients is challenging. Morbidly obese patients have documented differences in pharmacokinetic and pharmacodynamic properties compared to normal-weight patients, which impact antibiotic efficacy and toxicity. The Food and Drug Administration does not recognize obesity as a special population and does not require pharmaceutical companies to perform studies specific to obese patients. However, there are an increasing number of post-approval studies in obese patients, and this manuscript reviews available clinical and pharmacokinetic literature regarding weight-based antimicrobial agents. Additionally, we describe a single-centre approach to optimize dosing in morbidly obese patients. METHODS A comprehensive literature search was performed on 15 weight-based antimicrobials in the setting of obesity: acyclovir, aminoglycosides, amphotericin B, cidofovir, colistimethate, daptomycin, flucytosine, foscarnet, ganciclovir, quinupristin/dalfopristin, trimethoprim/sulfamethoxazole, vancomycin and voriconazole. A weight-based antimicrobial dosing guideline for morbidly obese patients was developed. An analysis of guideline compliance and cost analysis were performed following guideline implementation. RESULTS AND DISCUSSION This review describes the pharmacokinetic changes that occur in obese patients, including increased volume of distribution, altered hepatic metabolism, renal excretion and changes in protein binding. The majority of weight-based antimicrobials result in increased serum concentrations in morbidly obese patients compared to normal-weight patients when the calculated dose is based on actual body weight. WHAT IS NEW AND CONCLUSION This review demonstrates different antibiotic pharmacokinetic properties are altered in obese patients that could impact efficacy and toxicity. A single-centre guideline for weight-based antimicrobial dosing in obesity was developed and provides recommendations for using ideal body weight, adjusted body weight or actual body weight when calculating antimicrobial doses. However, more research is needed to better elucidate optimal dosing of weight-based antimicrobials in obesity, with particular focus on efficacy and toxicity.
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Affiliation(s)
- A K Polso
- Department of Pharmacy, University of Michigan Hospitals and Health Centers, Ann Arbor, MI, USA
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Haselden M, Leach M, Bohm N. Daptomycin dosing strategies in patients receiving thrice-weekly intermittent hemodialysis. Ann Pharmacother 2014; 47:1342-7. [PMID: 24259698 DOI: 10.1177/1060028013503110] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To determine the optimal dosing regimen of daptomycin in patients receiving thrice-weekly hemodialysis. DATA SOURCES Literature was accessed via PubMed using the terms daptomycin and hemodialysis through July 2013. Reference citations from publications identified were reviewed. STUDY SELECTION AND DATA EXTRACTION English language articles meeting the search criteria were evaluated. Studies were included if they addressed either thrice-weekly or intradialytic daptomycin administration. DATA SYNTHESIS Daptomycin is approved for the treatment of bloodstream infections due to methicillin-resistant Staphylococcus aureus and other Gram-positive organisms. Rapid bactericidal activity and limited potential for drug interactions make daptomycin an attractive agent. However, the daptomycin prescribing information recommends dosing every 48 hours in patients receiving hemodialysis, which results in dyssynchrony of dosing and dialysis sessions every other week. Studies evaluating a dosing regimen of daptomycin thrice weekly, coinciding with dialysis, indicate that pharmacokinetic and pharmacodynamic parameters are appropriate for therapeutic success. However, to maintain adequate serum drug concentrations throughout the 72-hour interdialytic period, an additional 50% of the dose should be provided to account for the longer interval. Intradialytic dosing, with the administration of daptomycin infusion beginning during the final 30 minutes of dialysis, may also require a dose increase. Limited clinical outcomes data have been reported, but no significant safety concerns have been identified. CONCLUSIONS Administration of daptomycin doses thrice weekly on hemodialysis days appears to be both safe and reasonable. Doses should be increased preceding the 72-hour interdialytic period or if daptomycin is infused during dialysis.
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Affiliation(s)
- Molly Haselden
- South Carolina College of Pharmacy/Medical University of South Carolina, Charleston, SC, USA
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Payne KD, Hall RG. Dosing of antibacterial agents in obese adults: does one size fit all? Expert Rev Anti Infect Ther 2014; 12:829-54. [DOI: 10.1586/14787210.2014.912942] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Kenna D Payne
- Texas Tech University Health Sciences Center,
1300 S. Coulter, Rm 323, Amarillo, TX 79106, USA
| | - Ronald G Hall
- Texas Tech University Health Sciences Center,
1300 S. Coulter, Rm 323, Amarillo, TX 79106, USA
- Dose Optimization and Outcomes Research (DOOR) Program,
5920 Forest Park Rd, Suite 400, Dallas, TX 75235, USA
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King ST, Walker ED, Cannon CG, Finley RW. Daptomycin-induced rhabdomyolysis and acute liver injury. ACTA ACUST UNITED AC 2014; 46:537-40. [PMID: 24801642 DOI: 10.3109/00365548.2014.901555] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Daptomycin use is a known cause of rhabdomyolysis; its role in liver injury is less certain. We report a case of daptomycin-induced rhabdomyolysis with liver injury. This report indicates a role for liver function monitoring while receiving daptomycin, as well as the importance of promptly considering drug toxicities in acute and emergency care settings.
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Affiliation(s)
- S Travis King
- From the Department of Pharmacy Practice, University of Mississippi School of Pharmacy
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DeVane CL. Pig Fat, Pork Bellies, and Portly Appearance. Pharmacotherapy 2013; 33:1297-8. [DOI: 10.1002/phar.1389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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