Treatment of Enterococcal Peritonitis with Intraperitoneal Daptomycin in a Vancomycin-Allergic Patient and a Review of the Literature |
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| Authors: | James F Gilmore Miae Kim Mary T LaSalvia Monica V Golik Mahoney |
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| Institution: | Department of Pharmacy Services,1. Brigham and Women’s Hospital, and Division of Infectious Diseases2. and Department of Pharmacy,3. Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA |
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| Abstract: | ♦ Background: Intraperitoneal (IP) administration of antibiotics is a mainstay of therapy in the treatment of peritoneal dialysis-related peritonitis. The therapeutic options against gram-positive organisms in patients intolerant to vancomycin are limited.♦ Methods: This case report and review of the literature used a search of PubMed with the terms “daptomycin,” “intraperitoneal,” and “peritoneal” for 2004 through 7 February 2013 to find relevant publications.♦ Results: In addition to our patient, we identified 6 case reports of IP daptomycin for the treatment of peritonitis. Our patient was treated with a 14-day course of IP daptomycin, with resolution of signs and symptoms of peritonitis. She presented again 7 weeks later with signs and symptoms of peritonitis and was treated with a repeat course of IP daptomycin. Among the 6 patients reported in the literature, 4 received loading doses of daptomycin. Daptomycin 20 mg per liter of dialysate was administered in 4 patients, and the other 2 patients received higher doses based on body weight (milligrams per kilogram). Treatment duration averaged 10 or 14 days. In all 6 cases, clinical cure was reported.♦ Conclusions: Although limited to case reports, the available literature suggests that IP daptomycin is a viable alternative for peritoneal dialysis-related peritonitis. However, routine use of this agent must be cautioned, because further prospective studies are required.Key words: Daptomycin, intraperitoneal, peritonitisIntraperitoneal (IP) vancomycin is a mainstay of therapy in treating peritoneal dialysis (PD)-related peritonitis. The therapeutic options for targeting gram-positive organisms are limited in patients intolerant to vancomycin. We describe our experience with IP daptomycin in a patient with a severe vancomycin allergy, and we review the available literature. A search of PubMed using the terms “daptomycin,” “intraperitoneal,” and “peritoneal” was conducted for 2004 through 7 February 2013. |
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