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Daptomycin underexposure in a young intravenous drug user who was affected by life-threatening Staphylococcus aureus-complicated skin and soft tissue infection associated with bacteraemia

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Abstract

We describe the case of an intravenous drug user affected by life-threatening Staphylococcus aureus-complicated skin and soft tissue infection with associated bacteraemia who, while on replacement therapy with methadone, required 11 mg/kg/day daptomycin to achieve trough (Cmin) and peak (Cmax) plasma levels similar to those observed with the standard dosage of 6 mg/kg in healthy volunteers (mean ± standard deviation: Cmin 12.35 ± 0.80 mg/L, Cmax 63.90 ± 8.71 mg/L). Clinical pharmacological advice based on real time therapeutic drug monitoring may be helpful for optimizing daptomycin exposure in these patients. Physicians should take into account that dosages much higher than the standard ones may be needed, probably as a consequence of augmented drug clearance.

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References

  1. Seaton RA. Daptomycin: rationale and role in the management of skin and soft tissue infections. J Antimicrob Chemother. 2008;62:iii15–23.

    Article  CAS  PubMed  Google Scholar 

  2. Roberts JA, Pea F, Lipman J. The clinical relevance of plasma protein binding changes. Clin Pharmacokinet. 2013;52:1–8.

    Article  CAS  PubMed  Google Scholar 

  3. Pea F. Plasma pharmacokinetics of antimicrobial agents in critically ill patients. Curr Clin Pharmacol. 2013;8:5–12.

    CAS  PubMed  Google Scholar 

  4. Pea F, Viale P. Bench-to-bedside review: appropriate antibiotic therapy in severe sepsis and septic shock—does the dose matter? Crit Care. 2009;13:214.

    Article  PubMed  Google Scholar 

  5. Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. 2004;32:1535–41.

    Article  PubMed  Google Scholar 

  6. Pea F, Cojutti P, Sbrojavacca R, Cadeo B, Cristini F, Bulfoni A, et al. TDM-guided therapy with daptomycin and meropenem in a morbidly obese, critically ill patient. Ann Pharmacother. 2011;45:e37.

    Article  PubMed  Google Scholar 

  7. Coughlin PA, Mavor AI. Arterial consequences of recreational drug use. Eur J Vasc Endovasc Surg. 2006;32:389–96.

    Article  CAS  PubMed  Google Scholar 

  8. Keeling AN, McGrath FP, Lee MJ. Interventional radiology in the diagnosis, management, and follow-up of pseudoaneurysms. Cardiovasc Intervent Radiol. 2009;32:2–18.

    Article  CAS  PubMed  Google Scholar 

  9. Mortin LI, Li T, Van Praagh AD, Zhang S, Zhang XX, Alder JD. Rapid bactericidal activity of daptomycin against methicillin-resistant and methicillin-susceptible Staphylococcus aureus peritonitis in mice as measured with bioluminescent bacteria. Antimicrob Agents Chemother. 2007;51:1787–94.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Safdar N, Andes D, Craig WA. In vivo pharmacodynamic activity of daptomycin. Antimicrob Agents Chemother. 2004;48:63–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Dvorchik BH, Brazier D, DeBruin MF, Arbeit RD. Daptomycin pharmacokinetics and safety following administration of escalating doses once daily to healthy subjects. Antimicrob Agents Chemother. 2003;47:1318–23.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Rybak MJ, Bailey EM, Lamp KC, Kaatz GW. Pharmacokinetics and bactericidal rates of daptomycin and vancomycin in intravenous drug abusers being treated for gram-positive endocarditis and bacteremia. Antimicrob Agents Chemother. 1992;36:1109–14.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. King CH, Creger RJ, Ellner JJ. Pharmacokinetics of tobramycin and gentamicin in abusers of intravenous drugs. Antimicrob Agents Chemother. 1985;27:285–90.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Rybak MJ, Lerner SA, Levine DP, Albrecht LM, McNeil PL, Thompson GA, et al. Teicoplanin pharmacokinetics in intravenous drug abusers being treated for bacterial endocarditis. Antimicrob Agents Chemother. 1991;35:696–700.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Gutkowska J, Schiller PW. Renal effects of TAPP, a highly selective mu-opioid agonist. Br J Pharmacol. 1996;119:239–44.

    Article  CAS  PubMed  Google Scholar 

  16. Lemaire S, Van Bambeke F, Mingeot-Leclercq MP, Tulkens PM. Modulation of the cellular accumulation and intracellular activity of daptomycin towards phagocytized Staphylococcus aureus by the P-glycoprotein (MDR1) efflux transporter in human THP-1 macrophages and madin-darby canine kidney cells. Antimicrob Agents Chemother. 2007;51:2748–57.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Bhavnani SM, Rubino CM, Ambrose PG, Drusano GL. Daptomycin exposure and the probability of elevations in the creatine phosphokinase level: data from a randomized trial of patients with bacteremia and endocarditis. Clin Infect Dis. 2010;50:1568–74.

    Article  CAS  PubMed  Google Scholar 

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Conflict of interest

Federico Pea and Matteo Bassetti have been a consultant to and on the speakers’ bureau of Novartis. Other authors: none.

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Authors and Affiliations

  1. Institute of Clinical Pharmacology, Azienda Ospedaliero–Universitaria Santa Maria Della Misericordia, Udine, Italy

    F. Pea & P. Cojutti

  2. Department of Experimental and Clinical Medical Sciences, Medical School, University of Udine, Udine, Italy

    F. Pea & P. Cojutti

  3. Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria Santa Maria Della Misericordia, Udine, Italy

    M. Crapis & M. Bassetti

Authors
  1. F. Pea
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  2. M. Crapis
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  3. P. Cojutti
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  4. M. Bassetti
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Corresponding author

Correspondence to F. Pea.

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Pea, F., Crapis, M., Cojutti, P. et al. Daptomycin underexposure in a young intravenous drug user who was affected by life-threatening Staphylococcus aureus-complicated skin and soft tissue infection associated with bacteraemia. Infection 42, 207–210 (2014). https://doi.org/10.1007/s15010-013-0511-2

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  • DOI: https://doi.org/10.1007/s15010-013-0511-2

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