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Successful Treatment of a Pacemaker Infection with Intraperitoneal Daptomycin

Anne B Taegtmeyer1, Nina Kononowa2, Dominique Fasel3

  • 1Division of Clinical Pharmacology and Toxicology, University Hospital Basel, Basel, Switzerland.

Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis
|February 4, 2016
PubMed

Insights

Intraperitoneal daptomycin effectively treats infections in peritoneal dialysis patients. Careful therapeutic drug monitoring and dose adjustments are crucial for achieving optimal daptomycin serum concentrations.

Area of Science:

  • Pharmacology
  • Nephrology
  • Infectious Diseases

Background:

  • Daptomycin is a crucial antibiotic for treating Gram-positive infections, including those caused by Staphylococcus epidermidis.
  • Peritoneal dialysis (PD) patients present unique challenges for antibiotic dosing due to altered drug pharmacokinetics.
  • Intraperitoneal (IP) administration offers a potential alternative route for antibiotic delivery in PD patients.

Observation:

  • A single PD patient with a pacemaker infection was treated with intravenous, then intraperitoneal daptomycin.
  • The initial IP daptomycin dose of 5.3 mg/kg every 48 hours resulted in supratherapeutic peak serum concentrations.
  • Therapeutic drug monitoring (TDM) guided a dose reduction to 3.2 mg/kg every 48 hours.

Findings:

  • Intraperitoneal daptomycin administration achieved serum concentrations above the minimal inhibitory concentration (MIC) in a PD patient.
  • Lower IP daptomycin doses may be sufficient compared to standard intravenous recommendations.
  • Serum drug concentration monitoring and dose adjustments are essential for safe and effective IP daptomycin therapy.

Implications:

  • Intraperitoneal daptomycin is a viable option for treating PD patients with specific infections.
  • Pharmacokinetic variability necessitates individualized dosing and TDM for IP daptomycin.
  • This case highlights the importance of adapting antibiotic strategies for PD patients to ensure therapeutic efficacy and safety.
Keywords:
Intraperitonealdaptomycinperitoneal dialysis

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