title: Daptomycin underexposure in a young intravenous drug user who was affected by life-threatening Staphylococcus aureus-complicated skin and soft tissue infection associated with bacteraemia.
abstract: We describe the case of an intravenous drug user affected by life-threatening Staphylococcus aureus-complicated skin and soft tissue infection with associated bacteraemia who, while on replacement therapy with methadone, required 11 mg/kg/day daptomycin to achieve trough (Cmin) and peak (Cmax) plasma levels similar to those observed with the standard dosage of 6 mg/kg in healthy volunteers (mean ± standard deviation: Cmin 12.35 ± 0.80 mg/L, Cmax 63.90 ± 8.71 mg/L). Clinical pharmacological advice based on real time therapeutic drug monitoring may be helpful for optimizing daptomycin exposure in these patients. Physicians should take into account that dosages much higher than the standard ones may be needed, probably as a consequence of augmented drug clearance.
authors.affiliation: Institute of Clinical Pharmacology, Azienda Ospedaliero-Universitaria Santa Maria Della Misericordia, Udine, Italy, pea.federico@aoud.sanita.fvg.it.
authors.forename: F
authors.initials: F
authors.lastname: Pea
authors.forename: M
authors.initials: M
authors.lastname: Crapis
authors.forename: P
authors.initials: P
authors.lastname: Cojutti
authors.forename: M
authors.initials: M
authors.lastname: Bassetti
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D016470:Bacteremia / Q000150:complications / Q000188:drug therapy*; D017576:Daptomycin / Q000008:administration & dosage / Q000493:pharmacokinetics*; D004347:Drug Interactions; D055030:Drug Users; D006801:Humans; D008691:Methadone / Q000008:administration & dosage*; D058850:Opiate Substitution Treatment; D010949:Plasma / Q000737:chemistry; D018461:Soft Tissue Infections / Q000150:complications / Q000188:drug therapy*; D013207:Staphylococcal Skin Infections / Q000150:complications / Q000188:drug therapy*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D000900:Anti-Bacterial Agents; D017576:Daptomycin; D008691:Methadone