Myojin Shota, Shoji Kensuke, Saito Jumpei, Tao Chiaki, Kato Hiroki, Uchida Hajime, Fukuda Akinari, Sakamoto Seisuke, Kasahara Mureo, Miyairi Isao
Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan.
Department of Pharmacy, National Center for Child Health and Development, Tokyo, Japan.
J Infect Chemother. 2025 Jan;31(1):102506. doi: 10.1016/j.jiac.2024.08.021. Epub 2024 Aug 30.
Information on the clinical utility of daptomycin in patients with persistent bacteremia and daptomycin's pharmacokinetic data in pediatric patients has been sparse. In addition, reports on the experience of using daptomycin in children undergoing solid organ transplantation have been extremely limited. The authors describe a pediatric case of persistent bacteremia after solid organ transplantation successfully treated by daptomycin. Blood daptomycin concentrations were measured by liquid chromatography-mass spectrometry and pharmacokinetic analysis was performed. We also conducted a literature review on the use of daptomycin in children with persistent bacteremia.
An eight-year-old girl who underwent small bowel and liver transplantation experienced persistent bacteremia due to Staphylococcus epidermidis. The bacteremia persisted despite standard therapy; however, it finally resolved with the addition of daptomycin. The patient had renal dysfunction and the initial dosing resulted in excessive drug exposure. The dosage was adjusted based on the pharmacokinetic analysis. The dosage of administrated teicoplanin was also adjusted according to trough concentration values. In the literature review, we identified 12 cases of neonates and 24 cases of post-neonatal children with the experience of using daptomycin for persistent bacteremia; however, no solid organ transplant recipient was identified. Similar trends in blood concentrations and dose ratios of teicoplanin and daptomycin were observed over time.
More information is required regarding the clinical utility and pharmacokinetics of daptomycin in pediatric patients with persistent bacteremia. Referring to the exposure to renally excreted drugs that are routinely measured and pharmacokinetic analysis of daptomycin may be useful in optimizing the dose of daptomycin in special patient populations, including those with renal impairment.
关于达托霉素在持续性菌血症患者中的临床应用以及其在儿科患者中的药代动力学数据的信息一直很少。此外，关于在实体器官移植儿童中使用达托霉素的经验报告极其有限。作者描述了一例实体器官移植后持续性菌血症的儿科病例，该病例通过达托霉素成功治疗。采用液相色谱 - 质谱法测定血液中的达托霉素浓度并进行药代动力学分析。我们还对达托霉素在持续性菌血症儿童中的应用进行了文献综述。
一名接受小肠和肝移植的8岁女孩因表皮葡萄球菌感染出现持续性菌血症。尽管进行了标准治疗，菌血症仍持续存在；然而，添加达托霉素后最终得以解决。该患者存在肾功能不全，初始给药导致药物暴露过量。根据药代动力学分析调整了剂量。还根据谷浓度值调整了替考拉宁的给药剂量。在文献综述中，我们确定了12例新生儿和24例新生儿后儿童有使用达托霉素治疗持续性菌血症的经验；然而，未发现实体器官移植受者。随着时间的推移，观察到替考拉宁和达托霉素的血药浓度和剂量比有相似趋势。
对于达托霉素在持续性菌血症儿科患者中的临床应用和药代动力学，还需要更多信息。参考常规测量的经肾脏排泄药物的暴露情况以及达托霉素的药代动力学分析，可能有助于优化特殊患者群体（包括肾功能损害患者）的达托霉素剂量。
