Tótoli Eliane Gandolpho, Garg Sanjay, Salgado Hérida Regina Nunes
*School of Pharmaceutical Sciences, Universidade Estadual Paulista, Araraquara, Brazil; and †Centre for Pharmaceutical Innovation and Development (CPID), University of South Australia, Adelaide, Australia.
Ther Drug Monit. 2015 Dec;37(6):699-710. doi: 10.1097/FTD.0000000000000222.
Daptomycin is the first approved member of a new class of antimicrobials, the cyclic lipopeptides, and presents selective action against gram-positive bacteria, including methicillin- and vancomycin-resistant strains. Considering that resistance to daptomycin is rare, the drug has become very important for current clinical practice. This review covers daptomycin's physicochemical characteristics, antibacterial spectrum, mechanism of action, pharmacokinetics, clinical applications, side effects, drug interactions, and the analytical methods used to measure daptomycin in pharmaceutical products and biologic samples. Special attention has been given to therapeutic drug monitoring reports, as studies have shown its highly variable pharmacokinetics in specific circumstances, such as in patients suffering from critical illness, morbid obesity, severe sepsis, and kidney injury. For the same reason, methods described for therapeutic drug monitoring of daptomycin in the special patient population have been reviewed. In addition, the review presents a discussion of environmentally friendly analytical methods for daptomycin, which are necessary to reduce the impact of our activities on the environment. However, it was observed that there is a gap in the literature in this regard and further research involving the development of "green" methodologies for the analysis of daptomycin is necessary. The review will be useful to the clinical community in assisting with the responsible use of daptomycin, which is critical to prevent the emergence of resistant strains.
达托霉素是一类新型抗菌药物（环脂肽）中首个获得批准的成员，对革兰氏阳性菌具有选择性作用，包括耐甲氧西林和耐万古霉素菌株。鉴于对达托霉素的耐药性罕见，该药在当前临床实践中变得非常重要。本综述涵盖达托霉素的物理化学特性、抗菌谱、作用机制、药代动力学、临床应用、副作用、药物相互作用以及用于测定药品和生物样品中达托霉素的分析方法。特别关注了治疗药物监测报告，因为研究表明其在特定情况下（如危重病患者、病态肥胖患者、严重脓毒症患者和肾损伤患者）的药代动力学高度可变。出于同样的原因，对特殊患者群体中达托霉素治疗药物监测所描述的方法进行了综述。此外，该综述还讨论了达托霉素的环境友好型分析方法，这对于减少我们的活动对环境的影响是必要的。然而，据观察，这方面的文献存在空白，有必要进一步开展涉及开发达托霉素“绿色”分析方法的研究。该综述将有助于临床界合理使用达托霉素，这对于防止耐药菌株的出现至关重要。
