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Infectious Disease and Epidemiology Associates, Omaha, NE; Infectious Disease Specialist, Alegent Health Immanuel Medical Center, Omaha
Pharmacy Practice Resident, Creighton University School of Pharmacy and Health Professions
Associate Professor of Pharmacy Practice, Creighton University School of Pharmacy and Health Professions; Clinical Pharmacist, Alegent Health Immanuel Medical Center
Chief, Section of Infectious Diseases; Professor, Department of Internal Medicine, University of Nebraska Medical Center, Omaha
Reprints: Shailaja R Veligandla MD, Infectious Disease and Epidemiology Associates, 4239 Farnam #710, Omaha, NE 68131-2830, fax 402/559-6354, himachalrao{at}yahoo.com
OBJECTIVE: To report a case of muscle pain without pronounced creatine kinase (CK) elevation in a patient receiving daptomycin.
CASE SUMMARY: A 26-year-old African American woman had antibiotic intolerance to vancomycin and quinupristin/dalfopristin. She presented with methicillin-resistant Staphylococcus aureus endocarditis that was treated with intravenous daptomycin 6 mg/kg daily for 14 days. The patient developed muscle aches and pains with only a minor elevation (492 U/L) of CK; both resolved after daptomycin was discontinued.
DISCUSSION: Daptomycin is a newly approved lipopeptide antibiotic derived from Streptomyces roseosporus with rapid bactericidal activity. Daptomycin has excellent coverage against gram-positive bacteria. The adverse effect profile has included rare reports of myopathy and elevated CK levels. Daptomycin is a promising agent with many potential applications. Once-daily dosing has diminished the preclinical incidence of myopathy. The current package labeling recommends discontinuation of daptomycin with significant myopathy symptoms in association with a CK elevation >1000 U/L or in patients without muscle pain and a CK >10 times normal.
CONCLUSIONS: An objective causality assessment revealed that the myopathy was possibly related to daptomycin. Clinicians should recognize that significant myopathy with daptomycin can occur without pronounced CK elevation.
Key Words: creatine kinase, daptomycin, myopathy
Published Online, September 14, 2004. www.theannals.com, DOI 10.1345/aph.1D639
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