High-dose, short-interval daptomycin regimen was safe and well tolerated in three patients with chronic renal failure
An 80-year-old woman who was diagnosed with infectious endocarditis due to methicillin-resistant Staphylococcus epidermis (MRSE) was administered daptomycin 5.9 mg/kg every other day, which is the regimen recommended in Japan (). Three days later, daptomycin was changed to linezolid because inflammation markers had not improved; however, on day 7, nausea developed, suggesting an adverse effect of linezolid, so teicoplanin was started. Four days later, improvement in inflammation markers, such as numbers of white blood cells and C-reactive protein level, was less than expected, and nausea continued.\nTherefore, we were consulted as infectious disease physicians; we suggested reinstituting daptomycin, but on a daily basis under careful observation, given that the every other day regimen had been ineffective on the first 3 days. Additional anti-MRSA drugs, such as rifampicin, were also considered, but the patient had a history of allergy to rifampicin. Unfortunately, mild interstitial pneumonia was subsequently seen on chest X-ray; however, the more expected adverse effects, such as elevation of CPK and creatinine, did not occur during the course of daptomycin treatment. The pneumonia improved with corticosteroid therapy soon after daptomycin administration was discontinued.