A Case of Confusion in an Obese Patient Treated With Daptomycin: Neurotoxicity

Area of Science:

• Pharmacology
• Infectious Diseases
• Neurology

Background:

• Daptomycin (DAP) is a potent cyclic lipopeptide antibiotic effective against Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA).
• Common adverse effects of DAP include myotoxicity (rhabdomyolysis), gastrointestinal issues, skin lesions, bleeding, and pulmonary complications.
• Neurotoxicity is a rare but reported adverse reaction to DAP, with mechanisms not fully understood.

Observation:

• A case report details a 73-year-old obese male patient treated with DAP (9 mg/kg) for MRSA bacteremia and associated infections.
• The patient experienced confusion and spatial disorientation on the fifth day of DAP treatment, coinciding with very high serum DAP concentrations.
• Neurological symptoms resolved completely upon discontinuation of DAP therapy.

Findings:

• The observed confusion and spatial disorientation were consistent with Daptomycin-induced neurotoxicity.
• High serum DAP concentrations in this obese patient likely contributed to the neurotoxic event.
• The patient's obesity was identified as a potential predisposing factor for DAP-related neurotoxicity.

Implications:

• This case highlights a potential association between Daptomycin and neurotoxicity, particularly confusion, in obese patients.
• Clinicians should maintain a high index of suspicion for neurological adverse events during DAP therapy.
• Dose reduction of Daptomycin in obese patients may be prudent to mitigate the risk of neurotoxicity.