Tuesday, December 30, 2008

Daptomycin: rationale and role in the management of skin and soft tissue infections.

Daptomycin: rationale and role in the management of skin and soft tissue infections.
J Antimicrob Chemother. 2008 Nov

Seaton RA.
Department of Infectious Diseases and General Medicine, Brownlee Centre, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, Scotland, UK.
andrew.seaton@ggc.scot.nhs.uk

The emergence of community-associated methicillin-resistant Staphylococcus aureus (MRSA) and glycopeptide tolerance in S. aureus has underlined the importance of the newer anti-MRSA agents, particularly in the management of complicated skin and soft tissue infections (cSSTIs). The novel cyclic lipopeptide antibiotic daptomycin shows marked in vitro cidality against MRSA compared with both vancomycin and linezolid. Although comparative studies in cSSTIs have demonstrated non-inferiority with vancomycin and semi-synthetic penicillins, data from both clinical trials and observational studies suggest in vivo cidality as evidenced by rapid resolution of clinical signs of local inflammation and reduced duration of therapy. Overall success in SSTI post-marketing studies is >90%, and >88% in MRSA-infected patients, with no difference in the outcome observed between those with complicated versus uncomplicated infections. When used at licensed doses (4-6 mg/kg), daptomycin is safe and effective in SSTIs with significant muscle toxicity occurring in only 0.4% to 2.5% of patients. Clinical failure in daptomycin-treated SSTIs is associated with severity of infection (creatinine clearance <30>

Journal of Antimicrorbial Chemotherapy

Daptomycin for methicillin-resistant Staphylococcus aureus infections of the spine.

Daptomycin for methicillin-resistant Staphylococcus aureus infections of the spine.
Spine J. 2008 Dec 26

Burdette SD.
Department of Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH 45409, USA.


BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) infection is increasingly common. Treatment with vancomycin-based therapy is often unsuccessful. Daptomycin is a relatively new lipopeptide antibiotic with potent activity against MRSA.

PURPOSE: To describe the successful management of MRSA infection involving the spine.

STUDY DESIGN: Two case reports of MRSA infection, one involving epidural and lumbar subdural abscesses, the other with osteomyelitis and discitis.

METHODS: Two cases are described, one with lumbar epidural and subdural abscesses and the other with osteomyelitis and discitis of the spine. Switching from vancomycin to daptomycin plus rifampin-based therapy resulted in patient improvement that allowed discharge from the hospital.

RESULTS: Both patients recovered fully from their infection.

CONCLUSIONS: Daptomycin is a safe and effective option for the treatment of MRSA infection involving the spine.

PMID: 19112049 [PubMed - as supplied by publisher]