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

By Gerard Guerin, DPM, CWS

Daptomycin was well tolerated in these trials of patients with complicated SSSIs, and the frequency, distribution and severity of adverse events were similar between daptomycin and comparator drugs.15 For example, 2.2 percent of patients treated with daptomycin experienced renal failure in comparison to 2.7 percent of patients in the comparator group.15 The prevalence of adverse events was similarly small and comparable between treatment groups among those patients who had diabetic ulcer infections.16 In contrast, a recent phase 3 trial of daptomycin 6 mg/kg for the treatment of S. 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.

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