Can Daptomycin Have An Impact With Skin And Skin Structure Infections?

Author(s): 
By Gerard Guerin, DPM, CWS
aureus bacteremia found significantly more patients had renal impairment with standard therapy (antistaphylococcal penicillin or vancomycin) (18 percent) than with daptomycin (7 percent).19 In regard to patients who receive daptomycin, one should monitor for the development of muscle pain and weakness, and also test creatinine phosphokinase (CPK) levels weekly or more often if necessary.11 However, elevations in CPK levels were comparable between daptomycin and comparator groups in the aforementioned complicated SSSI trials, and only two of 534 patients receiving daptomycin developed CPK levels that necessitated discontinuation of the drug.15 Final Notes The approved dose of daptomycin for complicated SSSI is 4 mg/kg once a day by intravenous infusion for seven to 14 days. When it comes to patients with insufficient renal function, the dosing should be once every 48 hours.11 Since many foot infections are caused or complicated by diabetes, parenteral therapy is often necessary at least initially.1,2 Since daptomycin is dosed once daily, it is a suitable modality for outpatient parenteral therapy. One study found that daptomycin is safe to use in a hospital-based outpatient setting. This provided the opportunity for patients to receive professional wound care in addition to drug administration.20 In summary, daptomycin has potent bactericidal activity against gram-positive bacteria, including MRSA. Given the currently available studies, it appears that this new antibiotic may provide a useful option for treating many skin infections of the foot. Dr. Guerin practices at the Foot and Wound Institute of the South in Hammond, La. Dr. Steinberg is an Assistant Professor in the Department of Plastic Surgery at the Georgetown University School of Medicine in Washington, D.C.
 

 

References:

1. Eron LJ, Lipsky BA, Low DE, et al. Managing skin and soft tissue infections: expert panel recommendations on key decision points. J Antimicrob Chemother 52 Suppl 1: i3-i17, 2003.

2. Lipsky BA, Berendt AR, Deery HG, et al. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis 39: 885-910, 2004.

3. Dang CN, Prasad YD, Boulton AJ, Jude EB. Methicillin-resistant Staphylococcus aureus in the diabetic foot clinic: a worsening problem. Diabet Med 20(2): 159-161, 2003.

4. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 32(8): 470-485, 2004.

5. Stevens DL. The role of vancomycin in the treatment paradigm. Clin Infect Dis 42 Suppl 1: S51-S57, 2006.

6. Hidayat LK, Hsu DI, Quist R, Shriner KA, Wong-Beringer A. High-dose vancomycin therapy for methicillin-resistant Staphylococcus aureus infections: efficacy and toxicity. Arch Intern Med 166(19): 2138-2144, 2006.

7. Centers for Disease Control and Prevention. Staphylococcus aureus resistant to vancomycin--United States, 2002. MMWR Morb Mortal Wkly Rep 51(26): 565-567, 2002.

8. Sakoulas G, Moise-Broder PA, Schentag J, et al. Relationship of MIC and bactericidal activity to efficacy of vancomycin for treatment of methicillin-resistant Staphylococcus aureus bacteremia. J Clin Microbiol 42(6): 2398-2402, 2004.

9. Howden BP, Ward PB, Charles PG, et al. Treatment outcomes for serious infections caused by methicillin-resistant Staphylococcus aureus with reduced vancomycin susceptibility. Clin Infect Dis 38(4): 521-528, 2004.

10. Silverman JA, Perlmutter NG, Shapiro HM. Correlation of daptomycin bactericidal activity and membrane depolarization in Staphylococcus aureus. Antimicrob Agents Chemother 47(8): 2538-2544, 2003.

11. Cubist Pharmaceuticals. Cubicin® (daptomycin for injection) prescribing information. 2006. Lexington, MA.

12. Rybak MJ, Hershberger E, Moldovan T, Grucz RG. In vitro activities of daptomycin, vancomycin, linezolid, and quinupristin-dalfopristin against staphylococci and enterococci, including vancomycin-intermediate and -resistant strains. Antimicrob Agents Chemother 44(4): 1062-1066, 2000.

Add new comment