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Daptomycin obesity

Sara Elizabeth Boyd, Esmita Charani, Tracy Lyons, Gary Frost, Alison Helen Holmes
BACKGROUND: Obesity is on course to overtake being underweight as a global disease burden. Obesity alters antibacterial pharmacokinetics (PK) and pharmacodynamics (PD). Historically, drug PK/PD parameters have not been studied in obese populations. This means dose recommendations risk being sub-therapeutic in a population at increased risk of infection. Suboptimal antibacterial prescribing is widely associated with treatment failure, worse clinical outcomes, unnecessary escalation to broad-spectrum therapy and the emergence of antimicrobial resistance (AMR)...
August 18, 2016: Journal of Antimicrobial Chemotherapy
John J Veillette, Puja Van Epps
OBJECTIVE: To report a case of ertapenem-induced hallucinations and delirium in an elderly, morbidly obese patient. SETTING/PRACTICE DESCRIPTION: A 71-year-old male was receiving intravenous antibiotics at an outside nursing facility through our Outpatient Parenteral Antimicrobial Therapy (OPAT) program, which has enrolled more than 800 patients since 2009. He was admitted to our medical center, a 673-bed tertiary health care facility, which provides care to more than 100,000 veterans in Northeast Ohio...
April 2016: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
Abdulaziz S Alobaid, Maya Hites, Jeffrey Lipman, Fabio Silvio Taccone, Jason A Roberts
The increased prevalence of obesity presents challenges for clinicians aiming to provide optimised antimicrobial dosing in the intensive care unit. Obesity is likely to exacerbate the alterations to antimicrobial pharmacokinetics when the chronic diseases associated with obesity exist with the acute pathophysiological changes associated with critical illness. The purpose of this paper is to review the potential pharmacokinetic (PK) changes of antimicrobials in obese critically ill patients and the implications for appropriate dosing...
April 2016: International Journal of Antimicrobial Agents
Eliane Gandolpho Tótoli, Sanjay Garg, Hérida Regina Nunes Salgado
Daptomycin is the first approved member of a new class of antimicrobials, the cyclic lipopeptides, and presents selective action against gram-positive bacteria, including methicillin- and vancomycin-resistant strains. Considering that resistance to daptomycin is rare, the drug has become very important for current clinical practice. This review covers daptomycin's physicochemical characteristics, antibacterial spectrum, mechanism of action, pharmacokinetics, clinical applications, side effects, drug interactions, and the analytical methods used to measure daptomycin in pharmaceutical products and biologic samples...
December 2015: Therapeutic Drug Monitoring
Ozgür Atmaca, Pınar Zarakolu, Ceren Karahan, Banu Cakır, Serhat Unal
The aim of this study was to evaluate methicillin-resistant Staphylococcus aureus (MRSA) bacteremia cases who were followed at the Infectious Diseases Unit of Internal Medicine Department, at Hacettepe University Adult and Oncology Hospitals between January 2004-December 2011. A total of 198 patients, of them 99 had positive MRSA blood cultures (case group), and 99 without MRSA bacteremia (control group) who were selected randomly among patients at the same wards during the same time period, were included in the study...
October 2014: Mikrobiyoloji Bülteni
Fernanda S Cavalcante, Dennis de C Ferreira, Raiane C Chamon, Thaina M da Costa, Fernanda Maia, Elaine M Barros, Tatiana Silva Dantas, Kátia R N Dos Santos
BACKGROUND: Daptomycin is an alternative option for the treatment of catheter-related bloodstream-infections caused by methicillin-resistant Staphylococcus aureus. This study reports a case of a daptomycin and methicillin-resistant Staphylococcus aureus isolate recovered from the blood of a Brazilian patient undergoing hemodialysis. CASE PRESENTATION: A 64-year-old white male patient suffering from diabetes mellitus, systolic hypertension, heart disease with a coronary stent, obesity and chronic renal failure and on use of permcath catheter developed a catheter-related bloodstream-infection by a daptomycin-methicillin-resistant Staphylococcus aureus isolate after one month of daptomycin therapy...
2014: BMC Research Notes
A K Polso, J L Lassiter, J L Nagel
WHAT IS KNOWN AND OBJECTIVE: Obesity is a significant burden on the healthcare system in the United States, and determining the appropriate antimicrobial dosing regimen in morbidly obese patients is challenging. Morbidly obese patients have documented differences in pharmacokinetic and pharmacodynamic properties compared to normal-weight patients, which impact antibiotic efficacy and toxicity. The Food and Drug Administration does not recognize obesity as a special population and does not require pharmaceutical companies to perform studies specific to obese patients...
December 2014: Journal of Clinical Pharmacy and Therapeutics
Kenna D Payne, Ronald G Hall
Obesity is a global pandemic affecting 33% of adults in the United States. Obese persons receiving cefazolin or fluconazole have been shown to have worse outcomes with suboptimal dosing. Studies evaluating the safety of colistin, daptomycin, and vancomycin have shown increased weight or obesity may potentially increase toxicity. Many antimicrobials lack pharmacokinetic data to support dose individuation in obese persons, due in part to the lack of obese patients in drug development studies. A one size fits all approach to dose optimization for obese patients is not likely...
July 2014: Expert Review of Anti-infective Therapy
Olga M Klibanov, Stephen Vickery, Cynthia Nortey
OBJECTIVE: To report a case of infective panniculitis in a morbidly obese, pregnant woman, which was successfully treated with daptomycin. CASE SUMMARY: A 34-year-old, 27-week pregnant, morbidly obese woman with a history of skin/soft-tissue infections and diabetes mellitus, presented with panniculitis. Initial treatment with β-lactam antibiotics did not result in clinical improvement. Methicillin-resistant Staphylococcus aureus was suspected, and 14 days of daptomycin 4 mg/kg (using total body weight) resulted in a clinical cure, without any adverse effects on the mother or the neonate...
May 2014: Annals of Pharmacotherapy
M Bassetti, M Baguneid, E Bouza, M Dryden, D Nathwani, M Wilcox
Complicated skin and soft tissue infections (cSSTIs) are a diverse group of infections, with a range of presentations and microbiological causes. Hospitalization is common for patients with a cSSTI, which is treated by drainage of the affected area and with antibiotics. Host factors such as co-morbidities, and microbial factors, in particular drug resistance, complicate the management of these infections. Methicillin-resistant Staphylococcus aureus (MRSA) is an important cSSTI pathogen in Europe, and its involvement can be associated with poor patient outcomes...
April 2014: Clinical Microbiology and Infection
J M Gutiérrez Urbón, P Linares Mondéjar, I Martin Herranz
Daptomycin is a cyclic lipopeptide antibiotic whose approved dose is 4 to 6 mg/kg/day. Today it is a matter of controversy the use of higher doses of daptomycin in a range of 8-12 mg/kg/ day, for the treatment of Staphylococcus aureus infections, justified by its concentration-dependent action and its tolerability and safety profile, but the available studies are inconclusive. Stratification is performed by groups of patients, on the recommendation of using doses above 6 mg/kg/day based on the PK/PD parameters predictive of efficacy and safety...
November 2013: Farmacia Hospitalaria
P Brandon Bookstaver, Christopher M Bland, Zaina P Qureshi, Carmen M Faulkner-Fennell, Margrit A Sheldon, Celeste R Caulder, Charles Hartis
STUDY OBJECTIVE: Data are limited for antimicrobial outcomes in obese patients. This study investigated the safety and clinical outcomes of daptomycin therapy in a hospitalized obese population in the southeastern United States. DESIGN: Multicenter retrospective cohort study. SETTING: Thirteen hospitals in the southeastern United States. PATIENTS: A total of 126 hospitalized adult obese patients (body mass index [BMI] more than 30 kg/m(2) ) admitted from January 2005 through May 2010 who received daptomycin dosed on actual body weight for any indication for a minimum of 7 days...
December 2013: Pharmacotherapy
Brett Janson, Karin Thursky
PURPOSE OF REVIEW: Obesity is becoming a major burden on healthcare systems worldwide. The management of infections is problematic due to both an increased risk of morbidity and mortality, as well as a lack of information about dosing of antibiotics in the obese population. Recommendations in this patient group are severely lacking, so clinicians need to consider pharmacokinetic/pharmacodynamic parameters and the relative risks of overdosing and underdosing. RECENT FINDINGS: Since 2011, articles on a number of antibiotics have been published, including cefazolin/cephazolin, cefepime, cefoxitin, clindamycin, cotrimoxazole, daptomycin, ertapenem, levofloxacin, linezolid, meropenem, moxifloxacin, piperacillin/tazobactam and vancomycin...
December 2012: Current Opinion in Infectious Diseases
Federico Pea, Piergiorgio Cojutti, Rodolfo Sbrojavacca, Barbara Cadeo, Francesco Cristini, Alessandro Bulfoni, Mario Furlanut
OBJECTIVE: To describe a case of severe cellulitis, successfully treated with high-dose daptomycin plus continuous infusion meropenem, in a patient with morbid obesity and renal failure, in whom drug exposure over time was optimized by means of real-time therapeutic drug monitoring (TDM). CASE SUMMARY: A 63-year-old man with morbid obesity (body mass index 81.6 kg/m²) and renal failure was admitted to the emergency department because of severe cellulitis. The patient had an admission Laboratory Risk Indicator for Necrotizing Fasciitis score of 9, and broad-spectrum antimicrobial therapy with daptomycin and meropenem was started...
July 2011: Annals of Pharmacotherapy
D A Figueroa, E Mangini, M Amodio-Groton, B Vardianos, A Melchert, C Fana, W Wehbeh, C M Urban, S Segal-Maurer
BACKGROUND: There are limited safety data for high-dose and long-term daptomycin treatment (16mg/kg administered for >or=14 days). We present our experience in 61 patients. METHODS: We performed a retrospective chart review for all patients treated with daptomycin at New York Hospital Queens (Flushing) from 1 January 2004 through 30 April 2007; patients were identified through a computerized hospital pharmacy database. RESULTS: Sixty-one patients (29 male and 32 female patients; mean age, 66...
July 15, 2009: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Joseph S Bubalo, Myrna Y Munar, Ganesh Cherala, Brandon Hayes-Lattin, Richard Maziarz
Daptomycin is the first antibacterial agent of the cyclic lipopeptides with in vitro bactericidal activity against gram-positive organisms, including vancomycin-resistant enterococci, methicillin-resistant staphylococci, and glycopeptide-resistant Staphylococcus aureus. The pharmacokinetics of daptomycin were determined in 29 adult oncology patients with neutropenic fever. Serial blood samples were drawn at 0, 0.5, 1, 2, 4, 8, 12, and 24 h after the initial intravenous infusion of 6 mg/kg of body weight daptomycin...
February 2009: Antimicrobial Agents and Chemotherapy
Manjunath P Pai, David T Bearden
As obesity continues to increase in prevalence throughout the world, it becomes important to explore the effects that obesity has on antimicrobial disposition. Physiologic changes in obesity can alter both the volume of distribution and clearance of many commonly used antimicrobials. These changes often present challenges such as estimation of creatinine clearance to predict drug clearance. Although these physiologic changes are increasingly being characterized, few studies assessing alterations in tissue drug distribution and the effects of obesity on antimicrobial pharmacokinetics have been published...
August 2007: Pharmacotherapy
Manjunath P Pai, Jeffrey P Norenberg, Tamara Anderson, Diane W Goade, Keith A Rodvold, Robert A Telepak, Renee-Claude Mercier
The present study characterized the single-dose pharmacokinetics of daptomycin dosed as 4 mg/kg of total body weight (TBW) in seven morbidly obese and seven age-, sex-, race-, and serum creatinine-matched healthy subjects. The glomerular filtration rate (GFR) was measured for both groups following a single bolus injection of [(125)I]sodium iothalamate. Noncompartmental analysis was used to determine the pharmacokinetic parameters, and these values were normalized against TBW, ideal body weight (IBW), and fat-free weight (FFW) for comparison of the two groups...
August 2007: Antimicrobial Agents and Chemotherapy
Manjunath P Pai, Renee-Claude Mercier, Sarah E Allen
OBJECTIVE: To report a case in which vancomycin clearance was used to determine the daptomycin dosing interval in a morbidly obese patient with renal impairment. CASE SUMMARY: 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...
March 2006: Annals of Pharmacotherapy
Cheryl A Burns
A 54-y-old morbidly obese male presented with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia secondary to chronic right hip arthroplasty infection. Bacteremia persisted despite prolonged vancomycin-based therapy (MIC < or = 1 microg/ml) and prosthetic removal. Adding daptomycin-rifampin resolved bacteremia within 48 h; hip cultures remained negative post-discharge. This case describes alternative treatment for chronic MRSA infections.
2006: Scandinavian Journal of Infectious Diseases
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