title: Clinical experience with daptomycin treatment of foot or ankle osteomyelitis: a preliminary study.
abstract: We retrospectively reviewed 25 patients with foot or ankle osteomyelitis reported to a registry who were treated with daptomycin. The patients' clinical experience was analyzed and described at a median dose of 6 mg/kg (range, 4-6.2 mg/kg) and a median duration of 38 days (range, 6-59 days). Twenty-three patients received daptomycin as secondary or tertiary therapy, primarily for not responding to their prior antibiotic therapy (n = 15). Concomitant antibiotics were given to 11 patients, mostly for Gram-negative and/or anaerobic coverage. Methicillin-resistant Staphylococcus aureus was the most common pathogen overall (15 of 25 patients). The median followup interval was 9 weeks (range, 0.5-77 weeks). Outcomes at the end of therapy were 16 patients' symptoms resolved, eight patients improved, and one patient did not respond to therapy; at followup, 19 patients' symptoms resolved, three patients improved, and three patients did not respond to therapy. Ongoing antibiotics were given to 52% of patients for a minimum of 8 days (median, 30 days; range, 8-232 days). Four patients with an implant (all removed) were successfully treated. Daptomycin appears promising for foot and ankle osteomyelitis caused by Gram-positive bacteria. Prospective, controlled clinical trials of daptomycin for osteomyelitis are warranted.
authors.affiliation: University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Holtom
authors.forename: Charalampos G
authors.initials: CG
authors.lastname: Zalavras
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Lamp
authors.forename: Nami
authors.initials: N
authors.lastname: Park
authors.forename: Lawrence V
authors.initials: LV
authors.lastname: Friedrich
mesh_terms: D000368:Aged; D000842:Ankle / Q000382:microbiology*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015897:Comorbidity; D017576:Daptomycin / Q000008:administration & dosage / Q000627:therapeutic use*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005528:Foot / Q000382:microbiology*; D006801:Humans; D008297:Male; D010019:Osteomyelitis / Q000188:drug therapy* / Q000453:epidemiology; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D017576:Daptomycin