Pharmacy Outcomes Research Group, Kaiser Permanente National Pharmacy, Aurora, CO.
Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO.
Perm J. 2021 May 26;25:20.297. doi: 10.7812/TPP/20.297.
Use of daptomycin at doses ≥ 6 mg/kg for treatment of osteomyelitis is increasing in clinical practice; unfortunately, limited data are available to guide optimal dosing and duration. The objective of this study was to assess daptomycin dosing and duration regimens for osteomyelitis treatment.
This was a retrospective, multi-site, cohort study conducted in an integrated healthcare delivery system. Nonpregnant patients ≥ 18 years of age with osteomyelitis diagnosed between November 1, 2003 and June 30, 2011, ≥ 2 weeks outpatient daptomycin therapy, and ≥ 1 month of follow-up were included. Daptomycin doses < 6 mg/kg and ≥ 6 mg/kg at durations of < 6 weeks and ≥ 6 weeks were examined with univariate and multivariate analyses to assess treatment success and all-cause mortality.
A total of 247 patients were included, with 39 (15.8%), 37 (15.0%), 107 (43.3%), and 64 (25.9%) receiving < 6 mg/kg and ≥ 6 weeks, < 6 mg/kg and < 6 weeks, ≥ 6 mg/kg and ≥ 6 weeks, and ≥ 6 mg/kg and < 6 weeks of daptomycin therapy, respectively. Patients had a mean age of 58 years and had received prior vancomycin therapy (65.6%). Patients receiving < 6 weeks of therapy were less likely to experience treatment success compared with ≥ 6 weeks (41.5% vs 25.3%, adjusted odds ratio = 0.55; 95% confidence interval = 0.31-0.98) independent of duration. There were no differences across groups in mortality after adjustment.
In a diverse clinical population, daptomycin for treatment of osteomyelitis of 6 weeks or longer duration was associated with success independent of dose. This finding supports longer treatment with daptomycin as a first-line agent in antimicrobial stewardship initiatives.
在临床实践中，使用剂量≥6 毫克/公斤的达托霉素治疗骨髓炎的情况正在增加；不幸的是，可用的数据有限，无法指导最佳剂量和持续时间。本研究的目的是评估骨髓炎治疗中达托霉素的剂量和持续时间方案。
这是一项在综合医疗服务系统中进行的回顾性、多地点、队列研究。纳入 2003 年 11 月 1 日至 2011 年 6 月 30 日期间诊断为骨髓炎、门诊接受达托霉素治疗≥2 周且随访时间≥1 个月的≥18 岁非妊娠患者。使用单变量和多变量分析检查剂量<6 毫克/公斤和≥6 毫克/公斤且持续时间<6 周和≥6 周的达托霉素治疗方案，以评估治疗成功率和全因死亡率。
共纳入 247 例患者，分别接受<6 毫克/公斤且持续时间≥6 周（39 例，15.8%）、<6 毫克/公斤且持续时间<6 周（37 例，15.0%）、≥6 毫克/公斤且持续时间≥6 周（107 例，43.3%）和≥6 毫克/公斤且持续时间<6 周（64 例，25.9%）的达托霉素治疗。患者的平均年龄为 58 岁，且均接受过万古霉素治疗（65.6%）。与持续时间≥6 周相比，接受<6 周治疗的患者治疗成功率较低（41.5%比 25.3%，调整后比值比=0.55；95%置信区间=0.31-0.98），但独立于持续时间。调整后各组死亡率无差异。
在多样化的临床人群中，持续 6 周或更长时间的达托霉素治疗骨髓炎与疗效相关，而与剂量无关。这一发现支持在抗菌药物管理计划中，将达托霉素作为一线药物进行更长时间的治疗。
