Literature analysis of rhabdomyolysis induced by daptomycin

Abstract

Objective To understand the clinical characteristics of daptomycin induced rhabdomyolysis. Methods PubMed, Elsevier Science Direct, Embase, Springer-link, Wiley Online Library, CNKI, and Wanfang Data (to January 2017) were searched and case reports on daptomycin induced rhabdomyolysis were collected. Data related to rhabdomyolysis induced by daptomycin were analyzed descriptively. Relevance evaluation of case reports in accordance with inclusion criteria were performed. Results A total of 10 patients with rhabdomyolysis induced by daptomycin were collected. Of 10 patients, 8 cases′s gender were recorded, including 3 males and 5 females. Their ages were 34 to 70 years and the average age was 54 years. There were no muscle pain or discomfort history in all patients. Daptomycin dosage in 4 patients (5~6 mg·kg-1·24 h-1) did not exceed the maximum dosage recommended in instructions; daptomycin dosage in 6 patients (7.2 mg·kg-1·48 h-1, 8 mg·kg-1·24 h-1, 6 mg·kg-1·12 h-1, 10 mg·kg-1·24 h-1 and 6.5 mg·kg-1·24 h-1) were higher than that recommended in instructions; daptomycin dosage in 1 patient was 500 mg·24 h-1 (the dosage could not be evaluated because of no body weight record). The time of rhabdomyolysis occurrence after daptomycin treatment was 2-16 days and the average time was 8 days. As the main clinical manifestations, 8 patients had myalgia, 6 patients had muscular weakness, and 2 patients had myoglobulinuria; serum CK levels were all abnormally elevated to 1 754-25 234 U/L with an average level of (13 044±8 351) U/L. Combination drugs in 9 patients were recorded; of them, the kinds of combination drugs were 1, 2, 3, 5, and 8 drugs in 2, 2, 2, 1, and 2 patients, respectively. The combination drugs included antilipemic, antibiotics, antidiabetic agents, antiviral drugs and etc. Daptomycin was stopped after rhabdomyolysis occurrence, symptomatic treatments were given; 5-18 days later, serum CK levels normalized in 4 patients, and 3-14 days later, serum CK levels decreased to some degrees (from 1 754-25 234 U/L to 125-7 647 U/L) in 5 patients; serum CK level normalized in 1 patient and the time was not mentioned. Symptoms were improved 5-14 days after daptomycin withdrawal in 3 patients and the improvement time was not mentioned in 7 patients. Relevance evaluation of adverse reactions were probably in 9 patients and possible in 1 patient. The rhabdomyolysis occurrence was related to frequency of administration in 2 patients. Conclusions Daptomycin alone or combined with other drugs may cause rhabdomyolysis. The frequency of administration is likely to be a risk factor. Stopping daptomycin and giving symptomatic treatments could improve symptoms and the serum CK levels may return to normal or markedly decrease within about 2 weeks. Key words: Daptomycin; Rhabdomyolysis