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Treatment of meningitis caused by vancomycin-resistant Enterococcus faecium: high-dose and combination daptomycin

Jennifer Le1, P Brandon Bookstaver, Celeste N Rudisill

  • 1Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California-San Diego, La Jolla, CA, USA. jenle@ucsd.edu

The Annals of Pharmacotherapy
|December 2, 2010
PubMed
Abstract

Insights

This study reports successful treatment of vancomycin-resistant Enterococcus faecium meningitis using daptomycin combined with gentamicin or linezolid. These findings offer hope for treating difficult central nervous system infections caused by resistant bacteria.

Area of Science:

  • Infectious Diseases
  • Neuroscience
  • Pharmacology

Background:

  • Meningitis caused by vancomycin-resistant Enterococcus faecium (VRE) presents significant treatment challenges due to microbial resistance and drug penetration into the cerebrospinal fluid (CSF).
  • Effective treatment strategies for VRE meningitis are limited, necessitating exploration of alternative therapeutic regimens.
  • Previous research indicates daptomycin's efficacy against certain resistant bacteria, including methicillin-resistant Staphylococcus aureus, and other serious enterococcal infections.

Observation:

  • Three adult male patients (aged 58-78 years) with VRE meningitis underwent treatment with daptomycin in combination with either linezolid or gentamicin.
  • The VRE isolates were susceptible to daptomycin, gentamicin, and linezolid in vitro.
  • Treatment involved 3-4 week regimens of daptomycin (6-12 mg/kg) plus either gentamicin or linezolid, with higher-than-approved daptomycin doses used in two cases.

Findings:

  • All three patients achieved clinical resolution and microbiological clearance of VRE from the CSF.
  • The combination therapy demonstrated successful outcomes despite challenges posed by drug kinetics, microbial resistance, and the presence of foreign bodies (shunts).
  • The addition of gentamicin or linezolid was based on in vitro synergy data and previous successful VRE meningitis treatments, respectively.

Implications:

  • Daptomycin, in combination with linezolid or gentamicin, represents a viable therapeutic option for treating VRE meningitis.
  • Higher doses of daptomycin may be beneficial for achieving adequate CSF concentrations.
  • Further controlled trials are warranted to establish optimal treatment strategies for VRE meningitis using daptomycin-based regimens.

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