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Angelini J, Liu S, Giuliano S, Flammini S, Martini L, Tascini C, Baraldo M, Pai MP. Revolutionizing Daptomycin Dosing: A Single 7-11 Hour Sample for Pragmatic Application. Clin Infect Dis 2024:ciae178. [PMID: 38552199 DOI: 10.1093/cid/ciae178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/10/2024] [Accepted: 03/12/2024] [Indexed: 06/19/2024] Open
Abstract
Precision daptomycin dosing faces clinical implementation barriers despite known exposure-safety concerns with the use of twice the regulatory-approved doses. We propose achieving a single 7-11 hour post-dose plasma target concentration of 30 mg/L to 43 mg/L to be a practical starting point to facilitate precision daptomycin dosing.
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Affiliation(s)
- Jacopo Angelini
- Clinical Pharmacology and Toxicology Institute, University Hospital Friuli Centrale ASUFC, 33100 Udine, Italy
- Department of Medicine (DMED), University of Udine (UNIUD), 33100 Udine, Italy
| | - Shuhan Liu
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
| | - Simone Giuliano
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy
| | - Sarah Flammini
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy
| | - Luca Martini
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy
| | - Carlo Tascini
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy
| | - Massimo Baraldo
- Clinical Pharmacology and Toxicology Institute, University Hospital Friuli Centrale ASUFC, 33100 Udine, Italy
- Department of Medicine (DMED), University of Udine (UNIUD), 33100 Udine, Italy
| | - Manjunath P Pai
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
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Calov S, Munzel F, Roehr AC, Frey O, Higuita LMS, Wied P, Rosenberger P, Haeberle HA, Ngamsri KC. Daptomycin Pharmacokinetics in Blood and Wound Fluid in Critical Ill Patients with Left Ventricle Assist Devices. Antibiotics (Basel) 2023; 12:antibiotics12050904. [PMID: 37237807 DOI: 10.3390/antibiotics12050904] [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: 04/02/2023] [Revised: 05/03/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Daptomycin is a cyclic lipopeptide antibiotic with bactericidal effects against multidrug-resistant Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecalis (VRE). For critically ill patients, especially in the presence of implants, daptomycin is an important therapeutic option. Left ventricle assist devices (LVADs) can be utilized for intensive care patients with end-stage heart failure as a bridge to transplant. We conducted a single-center prospective trial with critically ill adults with LVAD who received prophylactic anti-infective therapy with daptomycin. Our study aimed to evaluate the pharmacokinetics of daptomycin in the blood serum and wound fluids after LVAD implantation. Daptomycin concentration were assessed over three days using high-performance liquid chromatography (HPLC). We detected a high correlation between blood serum and wound fluid daptomycin concentration at 12 h (IC95%: 0.64 to 0.95; r = 0.86; p < 0.001) and 24 h (IC95%: -0.38 to 0.92; r = 0.76; p < 0.001) after antibiotic administration. Our pilot clinical study provides new insights into the pharmacokinetics of daptomycin from the blood into wound fluids of critically ill patients with LVADs.
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Affiliation(s)
- Stefanie Calov
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University of Tübingen, 72076 Tübingen, Germany
| | - Frederik Munzel
- Department of Anesthesiology and Intensive Care Medicine, BG Trauma Center, 72076 Tübingen, Germany
| | - Anka C Roehr
- Department of Pharmacy, General Hospital of Heidenheim, 89522 Heidenheim, Germany
| | - Otto Frey
- Department of Pharmacy, General Hospital of Heidenheim, 89522 Heidenheim, Germany
| | - Lina Maria Serna Higuita
- Department for Translational Bioinformatics and Medical Data Integration Center, Eberhard Karls University of Tübingen, 72076 Tübingen, Germany
| | - Petra Wied
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University of Tübingen, 72076 Tübingen, Germany
| | - Peter Rosenberger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University of Tübingen, 72076 Tübingen, Germany
| | - Helene A Haeberle
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University of Tübingen, 72076 Tübingen, Germany
| | - Kristian-Christos Ngamsri
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University of Tübingen, 72076 Tübingen, Germany
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3
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Role of Daptomycin in Cutaneous Wound Healing: A Narrative Review. Antibiotics (Basel) 2022; 11:antibiotics11070944. [PMID: 35884198 PMCID: PMC9311791 DOI: 10.3390/antibiotics11070944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 02/06/2023] Open
Abstract
Daptomycin is active against Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA) and the on-label indications for its use include complicated skin and skin structure infections (cSSSI). We performed a narrative review of the literature with the aim to evaluate the role of daptomycin in the skin wound healing process, proposing our point of view on the possible association with other molecules that could improve the skin healing process. Daptomycin may improve wound healing in MRSA-infected burns, surgical wounds, and diabetic feet, but further studies in humans with histological examination are needed. In the future, the combination of daptomycin with other molecules with synergistic action, such as vitamin E and derivates, IB-367, RNA III-inhibiting peptide (RIP), and palladium nanoflowers, may help to improve wound healing and overcome forms of antibiotic resistance.
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Hill DM, Boyd AN, Zavala S, Adams B, Reger M, Maynard KM, Adams TR, Drabick Z, Carter K, Johnson HA, Alexander KM, Smith L, Frye J, Gayed RM, Quan AN, Walroth TA. A review of the most impactful published pharmacotherapy-pertinent literature of 2019 and 2020 for clinicians caring for patients with thermal or inhalation injury. J Burn Care Res 2021; 43:912-920. [PMID: 34788823 DOI: 10.1093/jbcr/irab220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Keeping abreast with current literature can be challenging, especially for practitioners caring for patients sustaining thermal or inhalation injury. Practitioners caring for patients with thermal injuries publish in a wide variety of journals, which further increases the complexity for those with resource limitations. Pharmacotherapy research continues to be a minority focus in primary literature. This review is a renewal of previous years' work to facilitate extraction and review of the most recent pharmacotherapy-centric studies in patients with thermal and inhalation injury. Sixteen geographically dispersed, board-certified pharmacists participated in the review. A MeSH-based, filtered search returned 1,536 manuscripts over the previous 2-year period. After manual review and exclusions, only 98 (6.4%) manuscripts were determined to have a potential impact on current pharmacotherapy practices and included in the review. A summary of the 10 articles that scored highest are included in the review. Nearly half of the reviewed manuscripts were assessed to lack a significant impact on current practice. Despite an increase in published literature over the previous 2-year review, the focus and quality remain unchanged. There remains a need for investment in well-designed, high impact, pharmacotherapy-pertinent research for patients sustaining thermal or inhalation injuries.
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Affiliation(s)
- David M Hill
- Department of Pharmacy, Regional One Health, Memphis, TN
| | - Allison N Boyd
- Department of Pharmacy, Eskenazi Health, Indianapolis, IN
| | - Sarah Zavala
- Department of Pharmacy, Community Hospital, Munster, IN
| | - Beatrice Adams
- Department of Pharmacy, Tampa General Hospital, Tampa, FL
| | - Melissa Reger
- Department of Pharmacy, Community Regional Medical Center, Fresno, CA
| | - Kaylee M Maynard
- Department of Pharmacy, University of Rochester Medical Center, Rochester, NY
| | - Tori R Adams
- Department of Pharmaceutical Care, University of Iowa Health Care, Iowa City, IA
| | - Zachary Drabick
- Department of Pharmacy, University of Florida Health Shands Hospital, Gainesville, FL
| | - Kristen Carter
- Department of Pharmacy, UC Health University of Cincinnati Medical Center, Cincinnati, OH
| | - Heather A Johnson
- Department of Pharmacy, Methodist Hospital and Methodist Children's Hospital, San Antonio, TX
| | - Kaitlin M Alexander
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL
| | - Lisa Smith
- Department of Pharmacy, Doctors Hospital, Augusta, GA
| | - Jared Frye
- Department of Pharmaceutical Care, University of Iowa Health Care, Iowa City, IA
| | - Rita M Gayed
- Department of Pharmacy and Clinical Nutrition, Grady Health System, Atlanta, GA
| | - Asia N Quan
- Department of Pharmacy, The Arizona Burn Center Valleywise Health, Phoenix, AZ
| | - Todd A Walroth
- Department of Pharmacy, Eskenazi Health, Indianapolis, IN
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Musick KL, Jones SL, Norris AM, Hochstetler LJ, Williams FN, McKinzie BP. Evaluation of Voriconazole and Posaconazole Dosing in Patients with Thermal Burn Injuries. J Burn Care Res 2021; 43:802-807. [PMID: 34672325 DOI: 10.1093/jbcr/irab200] [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: 11/14/2022]
Abstract
Fungal infections are a recognized cause of increased morbidity and mortality in thermal burn patients. Adequate treatment regimens remain a challenge due to unpredictable pharmacokinetic/pharmacodynamic changes caused by a hypermetabolic state and individual patient factors. A retrospective evaluation of adult thermal burn patients from April 2014 to April 2020 was conducted to assess voriconazole and posaconazole antifungal dosing regimens. The primary outcome was the incidence of attaining a therapeutic steady-state trough level on the patient's initial voriconazole or posaconazole regimen. Of the 35 patients analyzed, 28 (80.0%) patients achieved a therapeutic level during azole therapy. However, only 13 (46.4%) patients achieved a therapeutic level on their first azole regimen. The median time to therapeutic level was 8.0 + 21.1 days from the start of azole therapy. Optimal dosing strategies for azole therapy in patients with thermal burns remains undefined. Further assessment is needed to delineate patient-specific factors that can contribute to subtherapeutic azole levels in thermal burn patients and the overall clinical impact of population-specific dosing regimens.
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Affiliation(s)
- Kaitlin L Musick
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, USA
| | - Savannah L Jones
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, USA
| | - Ashlyn M Norris
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, USA
| | - Lauren J Hochstetler
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, USA
| | - Felicia N Williams
- Jaycee Burn Center, University of North Carolina Medical Center, Chapel Hill, USA
| | - Brian P McKinzie
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, USA
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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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