Daptomicina en el tratamiento de las infecciones por grampositivos en pacientes con insuficiencia renal crónica

Abstract

Daptomycin is a cyclic lipopeptide that is effective in the treatment of Gram-positive infections, including those caused by multiresistant pathogens. This drug has rapid bactericidal action and low nephrotoxicity. Patients with severe renal failure show a dicrease in its renal clearance and an increase in the elimination half-life. The recommended dose in patients with creatinine clearance (CrCl) < 30ml/min is 4mg/kg/48h in skin and soft tissue infections and is 6mg/kg/48h in bacteremia and right endocarditis. Pharmacokinetic studies and data from the CORE Registry have allowed improved the dosing regimen in patients under hemodialysis, peritoneal dialysis and other extrarenal depuration techniques. Patients with a CrCl < 30ml/ min have rates of efficacy ranging between 69.2% and 96%, these rates being similar to or lower than those observed in patients with a CrCl > 30ml/min. Patients under hemodialysis may have higher rates of clinical failure. This article presents the preliminary results of the EUCORE in Spain. The presence of renal failure at the start of daptomycin therapy is not associated with an increase in the rates of severe adverse effects. Daptomycin has a good safety and efficacy profile for the treatment of infections in patients with chronic renal insufficiency. The consensus documents of distinct societies have incorporated the use of daptomycin in the treatment of bacteremia due to methicillin-resistant Staphylococcus aureus in patients with renal insufficiency.