Using vancomycin concentrations for dosing daptomycin in a morbidly obese patient with renal insufficiency

The Annals of Pharmacotherapy
Manjunath P PaiSarah E Allen

Abstract

To report a case in which vancomycin clearance was used to determine the daptomycin dosing interval in a morbidly obese patient with renal impairment. A 46-year-old man (209 kg; 178 cm) failed a 42 day course of vancomycin therapy for treatment of a methicillin-resistant Staphylococcus aureus-infected wound and cellulitis. The median trough vancomycin concentration was 12.6 microg/mL (range 7.3-24.1) through his course of therapy. Estimation of creatinine clearance (Cl(cr)) was confounded in this clinical scenario, given the patient's weight and a lack of valid equations in this patient population. Daptomycin was administered empirically at 6 mg/kg dosed every 48 hours based on estimated clearance from measured vancomycin concentrations. Steady-state plasma concentrations of daptomycin were determined, and the daptomycin half-life in this patient was more accurately estimated using vancomycin clearance as a surrogate. In addition, a 4 mg/kg dose of daptomycin would have been sufficient based on plasma concentrations. The patient demonstrated rapid clinical improvement and remained free of cellulitis for 6 months after completion of daptomycin and a 12 week course of trimethoprim/sulfamethoxazole. The dosing interval of daptomyc...Continue Reading

References

Jan 1, 1976·Nephron·D W Cockcroft, M H Gault
Dec 22, 1998·European Journal of Clinical Pharmacology·L A BauerJ S Lill
May 12, 2000·American Journal of Physiology. Renal Physiology·A ChagnacU Gafter
Aug 16, 2002·American Journal of Clinical Dermatology·Linda García Hidalgo
Oct 9, 2002·JAMA : the Journal of the American Medical Association·Katherine M FlegalClifford L Johnson
Mar 26, 2003·Antimicrobial Agents and Chemotherapy·Barry H DvorchikRobert D Arbeit
Feb 19, 2004·Drugs·Caroline FentonMonique P Curran
Jul 1, 2004·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Robert D ArbeitUNKNOWN Daptomycin 98-01 and 99-01 Investigators
Jul 27, 2004·Antimicrobial Agents and Chemotherapy·Barry DvorchikHelen Kastrissios
Dec 17, 2004·Journal of Clinical Pharmacology·Barry H Dvorchik, David Damphousse
May 27, 2005·Antimicrobial Agents and Chemotherapy·John WeigeltUNKNOWN Linezolid CSSTI Study Group
Jul 29, 2005·Antimicrobial Agents and Chemotherapy·Elisabeth KugelbergDiarmaid Hughes

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Citations

Jun 6, 2007·Antimicrobial Agents and Chemotherapy·Manjunath P PaiRenee-Claude Mercier
Oct 10, 2008·The Journal of Antimicrobial Chemotherapy·R E Warren
Sep 11, 2007·Infectious Disease Clinics of North America·Scott J BergmanJanak Koirala
Oct 9, 2012·Current Opinion in Infectious Diseases·Brett Janson, Karin Thursky

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