title: Muscle pain associated with daptomycin.
abstract: OBJECTIVE
  To report a case of muscle pain without pronounced creatine kinase (CK) elevation in a patient receiving daptomycin.
  
  
  METHODS
  A 26-year-old African American woman had antibiotic intolerance to vancomycin and quinupristin/dalfopristin. She presented with methicillin-resistant Staphylococcus aureus endocarditis that was treated with intravenous daptomycin 6 mg/kg daily for 14 days. The patient developed muscle aches and pains with only a minor elevation (492 U/L) of CK; both resolved after daptomycin was discontinued.
  
  
  CONCLUSIONS
  Daptomycin is a newly approved lipopeptide antibiotic derived from Streptomyces roseosporus with rapid bactericidal activity. Daptomycin has excellent coverage against gram-positive bacteria. The adverse effect profile has included rare reports of myopathy and elevated CK levels. Daptomycin is a promising agent with many potential applications. Once-daily dosing has diminished the preclinical incidence of myopathy. The current package labeling recommends discontinuation of daptomycin with significant myopathy symptoms in association with a CK elevation >1000 U/L or in patients without muscle pain and a CK >10 times normal.
  
  
  CONCLUSIONS
  An objective causality assessment revealed that the myopathy was possibly related to daptomycin. Clinicians should recognize that significant myopathy with daptomycin can occur without pronounced CK elevation.
authors.affiliation: Alegent Health Immanuel Medical Center, Omaha, NE, USA. himachalrao@yahoo.com
authors.forename: Shailaja R
authors.initials: SR
authors.lastname: Veligandla
authors.forename: Kathy R
authors.initials: KR
authors.lastname: Louie
authors.forename: Mark A
authors.initials: MA
authors.lastname: Malesker
authors.forename: Philip W
authors.initials: PW
authors.lastname: Smith
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D017576:Daptomycin / Q000009:adverse effects*; D005260:Female; D006801:Humans; D009135:Muscular Diseases / Q000139:chemically induced*; D010146:Pain / Q000139:chemically induced*
chemical_list: D000900:Anti-Bacterial Agents; D017576:Daptomycin