Treatment of Enterococcal Peritonitis with Intraperitoneal Daptomycin in a Vancomycin-Allergic Patient and a review of the literature

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.