Daptomycin
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Elevated creatine phosphokinase level: case report A 29-year-old man exhibited elevated creatine phosphokinase (CPK) levels during treatment with daptomycin. The man presented to a hospital with chief complaints of generalised weakness, dizziness and fever. He had a significant history of hypertension, dyslipidaemia, end-stage renal disease (ESRD), for which he was on haemodialysis. At the time admission, his body temperature was 103.2°F, BP was 82/44mm Hg and heart rate was 180 bpm. In the emergency department, he was defibrillated twice for ventricular tachycardia. Subsequently, he was administered Ringer’s-lactate and immediately admitted to the ICU. He started receiving norepinephrine, linezolid and cefepime. However, infectious disease physician switched linezolid to daptomycin 6 mg/kg every 48 hours (450mg once on day 1 and 650mg once on day 3) [route not stated] due to suspected septic shock secondary to bacteraemia from haemodialysis line infection. The catheter was removed. Subsequent culture examination showed growth of methicillin-resistant Staphylococcus aureus (MRSA), which was negative after 2 days. At the time of his admission, his CPK level was 109 U/L. On hospital day 3, his CPK level increased to 1 604 U/L. By day 7 of daptomycin therapy, his CPK further elevated to 2 557 U/L. Concurrently, he was receiving various other therapies, including unspecified albumin. The man’s daptomycin was therefore discontinued and he was switched to ceftaroline. On day 3 of ceftaroline treatment, his CPK was found to be 462 U/L. A decision was made to restart daptomycin 6 mg/kg every 48 hours. The man was restarted with daptomycin for MRSA bacteraemia. On day 3, after daptomycin re-initiation, the CPK level continued to decrease to 105 U/L. On day 5, the CPK level was 66 U/L. Once daptomycin was restarted, he received 6 additional days of therapy to complete a total of 15 days of effective therapy (daptomycin and ceftaroline). Subsequently, he was discharged from the hospital. Throughout his hospitalisation, he did not experience any symptoms of myalgia or muscle weakness. Based on the Naranjo adverse drug reaction probability score (score of +5), a causal relation between daptomycin and CPK level elevation was assessed as probable. Koh L, et al. Patient Case Report Daptomycin Holiday-A Daptomycin Dosing Strategy for Asymptomatic Increases in Creatine Phosphokinase Levels. Journal of Pharmacy 803507855 Practice : 2020. Available from: URL: http://doi.org/10.1177/0897190020958233
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Reactions 17 Oct 2020 No. 1826
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