High-dose, short-interval daptomycin regimen was safe and well tolerated in three patients with chronic renal failure
An 85-year-old man who had undergone surgery for urinary bladder tumors was admitted because urinary infection was suspected. There were no findings indicating pyelonephritis by ultrasound examination, but meropenem 0.5 g twice daily was begun empirically by the primary physicians because of their suspicion of severe sepsis due to Gram-negative rods, including extended-spectrum beta-lactamase-producing strains of Escherichia coli and Klebsiella species, which are seen (about >20%) in urology patients in Japan (). However, 2 days later, MRSA, with a minimum inhibitory concentration for vancomycin of 1 μg/mL (susceptible), was isolated from the blood culture, and vancomycin was started at a dose determined by the renal function (creatinine clearance 16.3 mL per minute). The dosage of meropenem and vancomycin determined by the primary physicians was quite low at first (half of the usual) because of concern for possible deterioration of renal function. In fact, vancomycin was ineffective and the trough level was quite low (7.8 μg/mL). Further, MRSA was again isolated from the day 3 blood culture, and inflammation indicators, such as white blood cells and C-reactive protein level, had not improved. Indicators of the physical condition of the patient, such as blood pressure and respiratory status, had also worsened; therefore, we were consulted and, because of our experiences with cases 1 and 2, we again suggested that vancomycin should be changed to daptomycin 8 mg/kg daily under careful observation. After administration of daptomycin, blood cultures became negative for MRSA, and inflammation markers also improved. No adverse effects were noted, including no decreased creatinine clearance.