"There is limited clinical knowledge about daptomycin use in patients with impaired renal function such as those on dialysis, because patients with kidney disease were excluded from clinical trials with the daptomycin," said Jignesh Patel, PharmD, clinical pharmacist, University of Michigan, Ann Arbor.

In a poster presentation on November 18^th, Dr. Patel reported the results of a study on 81 patients who were treated with daptomycin, one of the few backup antibiotics that are available to treat vancomycin-resistant Gram positive bacteria.

Among the 81 patients treated were 32 patients infected with methicillin-resistant Staphylococcus aureus and 27 patients infected with vancomycin-resistant enterococci species, Dr. Patel said.

The initial dose was a mean of 5.1 mg/kg. Most of the patients were treated every 48 hours, but 12 patients were treated every 24 hours; 11 were treated 3 times weekly and 3 patients were given a single dose. Some patients received dosing in a mixture of schedules.

Overall, 69 (85%) of the 81 patients responded to the drug, with 37 patients (46%) being cure of their infection with daptomycin and 32 showing improvement when the drug was administered. There were 12 patients who failed to respond to treatment (15%).

In addition to daptomycin, patients also received fluoroquinolones, penicillin and carbapenems. Before getting daptomycin, the patients had been treated with a wide variety of antibiotics, including vancomycin, linezolid and cephalosporins.

Most of the patients had infections caused by their needlesticks of central lines becoming colonized with bacteria, Dr. Patel said.

He said the study was limited in its ability to be generalized.

"Prospective, randomized, controlled clinical studies are warranted to determine if daptomycin is safe and effective for infections including bacteremia and osteomyelitis caused by methicillin-resistant S. aureus and vancomycin-resistant enterococci in hemodialysis patients," he said.

This study was funded by Cubist Pharmaceuticals, Lexington, Massachusetts.


[Presentation title: Efficacy and Safety of Daptomycin (DAP) in Patients (Pts) Receiving Hemodialysis (HD). Abstract SA-PO328]

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