Effectiveness and safety of daptomycin in pediatrics

Antimicrobial resistance is an increasing challenge in Public Health, particularly due to the prevalence of methicillin-resistant Staphylococcus aureus (MRSA). Daptomycin is known to be useful in complicated infections caused by this microorganism, although the evidence in pediatrics is still limited. The objectives are to describe the clinical and microbiological effectiveness of daptomycin in the pediatric population of a tertiary care hospital. Furthermore, to detail the prescribed doses, microorganisms causing the infection, antibiotics used in synergy and the number of patients who presented elevated creatine phosphokinase (CK) and/or eosinophilia.

This was a single-center, retrospective, observational study. Hospitalized pediatric patients who received at least one dose of daptomycin were included. Demographic, microbiological, pharmacological, and clinical variables were analyzed. Safety was assessed using CK and eosinophil levels before and after daptomycin treatment.

Forty-four patients were included (72.7% men; median age: 9.9 years). The main indications for which it was prescribed were skin and soft tissue infections (43.2%) and osteoarticular infections (27.3%), followed by endocarditis (11.4%) and catheter-associated bacteremia (11.4%). The median prescribed dose was 9.0 mg/kg. Daptomycin was used empirically in 52.3% of cases and as first-line treatment in 15.9%. Microbiological isolation was confirmed in 65.9% of patients, with methicillin-susceptible S. aureus (MSSA) being the most frequently isolated microorganism (48.3%), followed by MRSA (27.6%). Microbiological cure was confirmed in 34.5% of patients with isolation. Clinical improvement was observed in 84.1% of cases. No patients died. Regarding safety, in patients for whom CK levels were available, no elevations were observed and no treatment was discontinued due to toxicity.

Daptomycin showed a high rate of clinical effectiveness. In patients for whom CK levels were available, no elevations were observed; however, the small number of patients monitored limits the interpretation of safety. Its use was largely empirical. These findings support its consideration as a therapeutic alternative in this group of patients, although prospective, controlled studies are needed to strengthen the evidence in the pediatric population.