Abstract
Antimicrobial resistance (AR) is a problem that threatens the search for adequate safe and effective antibiotic therapy against multi-resistant bacteria like methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococci (VRE) and Clostridium difficile, among others. Daptomycin is the treatment of choice for some infections caused by Gram-positive bacteria, indicated most of the time in patients with special clinical conditions where its high pharmacokinetic variability (PK) does not allow adequate plasma concentrations to be reached. The objective of this review is to describe the data available about the type of therapeutic drug monitoring (TDM) method used and described so far in hospitalized patients with daptomycin and to describe its impact on therapeutic success, suppression of bacterial resistance, and control of side effects. The need to create worldwide strategies for the appropriate use of antibiotics is clear, and one of these is the performance of therapeutic drug monitoring (TDM). TDM helps to achieve a dose adjustment and obtain a favorable clinical outcome for patients by measuring plasma concentrations of an administered drug, making a rational interpretation guided by a predefined concentration range, and, thus, adjusting dosages individually.
Highlights
The World Health Organization (WHO) has reviewed in detail the increase in antimicrobial resistance (AR), which represents a threat to health worldwide [1]
Other methods were found, such as ultrahigh-performance liquid chromatography equipped with a photodiode array (UHPLCPDA) [32,49], Bayesian estimation [21], and liquid chromatography using a core-layer octadecylsilyl microparticle coupled to tandem mass spectrometry [20]
-therapeutic drug monitoring (TDM) was performed: before, 4 h after, and 24 h after the 1st dose -Cmax: 4 h -At 24 h: daptomycin CL from intraperitoneal dialysis was determined -Daptomycin: 5.3 mg/kg every 48 h reached Cmax -The dose was reduced to 4.3 mg/kg every 48 h and to 3.2 mg/kg every 48 h -The target Cmin and Cmax were reached on day 22 -The dose was maintained at 300 mg (3.2 mg/kg) intraperitoneally every 48 h until day 32
Summary
The World Health Organization (WHO) has reviewed in detail the increase in antimicrobial resistance (AR), which represents a threat to health worldwide [1]. Due to the great spread of multi-resistant (MDR) and pan-resistant bacteria that have acquired various multi-resistance mechanisms, these are compromising the ability of antibiotics to control infection and produce a favorable clinical outcome for patients [3] Due to this situation, the WHO has classified MDR bacteria into two different groups according to the priority regarding antimicrobial therapy and the development of new antibiotics [4]. A list of antibiotic resistant bacteria was reported, describing some Grampositive bacteria such as Methicillin-resistant Staphylococcus aureus (MRSA) and vancomycinresistant Enterococci (VRE) and Clostridium difficile These microorganisms comprise 7 of the 18 urgent and serious AR-related threats described by the United States Centers for Disease Control and Prevention (CDC) [5], and they are one of the main risk factors associated with in-hospital mortality [6,7,8]. There are two antibiotics approved by the US Food and Drug Administration (FDA) for the treatment of MRSA bacteremia and endocarditis: vancomycin and daptomycin [10]
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