Successful treatment of infective panniculitis with daptomycin in a pregnant, morbidly obese patient.

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.

DISCUSSION: Panniculitis is a type of skin/soft-tissue infection that is often caused by Gram-positive microorganisms. Daptomycin is one of the recommended agents for the treatment of skin/soft-tissue infections in hospitalized patients; however, it has not been extensively studied in pregnancy or morbid obesity. Some data suggest that exposure to daptomycin is significantly increased in morbidly obese persons because of the higher total dose received in this patient population. Animal data suggest that this drug is safe in pregnancy (category B), and at the time of publication, 3 prior cases of safe use of daptomycin in pregnancy have been reported.

CONCLUSIONS: This case provides additional evidence for the use of daptomycin in pregnancy as well as morbid obesity.