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Safety and Effectiveness of Daptomycin Across a Hospitalized Obese Population: Results of a Multicenter Investigation in the Southeastern United States
Author(s) -
Bookstaver P. Brandon,
Bland Christopher M.,
Qureshi Zaina P.,
FaulknerFennell Carmen M.,
Sheldon Margrit A.,
Caulder Celeste R.,
Hartis Charles
Publication year - 2013
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.1298
Subject(s) - medicine , discontinuation , body mass index , daptomycin , adverse effect , population , retrospective cohort study , incidence (geometry) , rhabdomyolysis , overweight , surgery , physics , environmental health , vancomycin , biology , bacteria , optics , genetics , staphylococcus aureus
Study Objective Data are limited for antimicrobial outcomes in obese patients. This study investigated the safety and clinical outcomes of daptomycin therapy in a hospitalized obese population in the southeastern U nited S tates. Design Multicenter retrospective cohort study. Setting Thirteen hospitals in the s outheastern U nited S tates. Patients A total of 126 hospitalized adult obese patients (body mass index [ BMI ] more than 30 kg/m 2 ) admitted from January 2005 through May 2010 who received daptomycin dosed on actual body weight for any indication for a minimum of 7 days. Measurements and Main Results Primary safety outcomes included incidence of creatine phosphokinase ( CPK) elevations more than 1000 units/L, more than 500 units/L, myalgias, and discontinuation of therapy due to adverse drug events ( ADEs ). Patients were stratified by BMI class ( I , II, or III ) for analyses. The average weight was 121 kg, and 39% of patients were considered morbidly obese. Factors associated with an increased risk of primary safety outcomes were assessed through regression analysis. Clinical effectiveness was evaluated as a secondary outcome. CPK elevations more than 1000 units/L occurred in 8.4% of evaluable patients and specifically in 1 (3.6%), 3 (10.3%), and 4 (10.5%) patients in BMI class I , II, and III , respectively (p=0.554). CPK elevations more than 500 units/L occurred in 13.7% of patients with no statistically significant difference noted across BMI classes. Discontinuation due to ADEs occurred in 8 patients (6.3%). One patient developed rhabdomyolysis on day 9 of therapy. Clinical effectiveness was documented in 71% of patients and was consistent across BMI classes. Conclusion Although elevations in CPK increased in high‐risk obese patients on daptomycin, discontinuation rates due to ADEs remained low. Further evaluation in a prospective trial is warranted.