South Carolina College of Pharmacy/Medical University of South Carolina, Charleston, SC, USA.
Ann Pharmacother. 2013 Oct;47(10):1342-7. doi: 10.1177/1060028013503110.
To determine the optimal dosing regimen of daptomycin in patients receiving thrice-weekly hemodialysis.
Literature was accessed via PubMed using the terms daptomycin and hemodialysis through July 2013. Reference citations from publications identified were reviewed.
English language articles meeting the search criteria were evaluated. Studies were included if they addressed either thrice-weekly or intradialytic daptomycin administration.
Daptomycin is approved for the treatment of bloodstream infections due to methicillin-resistant Staphylococcus aureus and other Gram-positive organisms. Rapid bactericidal activity and limited potential for drug interactions make daptomycin an attractive agent. However, the daptomycin prescribing information recommends dosing every 48 hours in patients receiving hemodialysis, which results in dyssynchrony of dosing and dialysis sessions every other week. Studies evaluating a dosing regimen of daptomycin thrice weekly, coinciding with dialysis, indicate that pharmacokinetic and pharmacodynamic parameters are appropriate for therapeutic success. However, to maintain adequate serum drug concentrations throughout the 72-hour interdialytic period, an additional 50% of the dose should be provided to account for the longer interval. Intradialytic dosing, with the administration of daptomycin infusion beginning during the final 30 minutes of dialysis, may also require a dose increase. Limited clinical outcomes data have been reported, but no significant safety concerns have been identified.
Administration of daptomycin doses thrice weekly on hemodialysis days appears to be both safe and reasonable. Doses should be increased preceding the 72-hour interdialytic period or if daptomycin is infused during dialysis.
确定接受每周三次血液透析的患者中达托霉素的最佳剂量方案。
通过 2013 年 7 月之前在 PubMed 上使用达托霉素和血液透析这两个术语检索文献，同时查阅已确定文献的参考文献。
评估符合搜索标准的英文文章。如果研究涉及每周三次或血液透析内达托霉素给药，则将其纳入研究。
达托霉素获批用于治疗耐甲氧西林金黄色葡萄球菌和其他革兰氏阳性菌引起的血流感染。快速杀菌活性和有限的药物相互作用潜力使达托霉素成为一种有吸引力的药物。但是，达托霉素使用说明书建议在接受血液透析的患者中每 48 小时给药一次，这导致每周两次的给药和透析治疗不同步。评估每周三次、与透析同时给药的达托霉素剂量方案的研究表明，药代动力学和药效学参数适合治疗成功。然而，为了在 72 小时的无透析间隔期间维持足够的血清药物浓度，需要额外增加 50%的剂量以补偿更长的间隔时间。在血液透析期间开始给予达托霉素输注的透析内给药，可能也需要增加剂量。已报告了有限的临床结局数据，但未发现明显的安全问题。
在血液透析日每周三次给予达托霉素剂量似乎既安全又合理。如果在 72 小时无透析间隔之前或在透析期间输注达托霉素，则应增加剂量。
