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Daptomycin appears to be a suitable, once-a-day alternative for treating gram-positive complicated s

Photo of a colorized scanning electron micrograph of MRSA. This image was provided by the National Institute of Allergy and Infectious Diseases.

Once-daily IV daptomycin, dosed by age, appears to be safe and effective in children for treating complicated skin and skin structure infections (cSSSI) caused by gram-positive pathogens, according to findings published online ahead of print in Pediatrics (Feb. 13, 2017).

In the paper, the authors note that cSSSIs are common in children, but there are safety and resistance issues with the recommended antibiotics in this age group. To compare daptomycin to the standard of care (SOC), investigators conducted a multicentre, evaluator-blinded clinical trial. Patients one to 17 years of age with cSSSI caused by Gram-positive pathogens were randomized 2:1 to receive either intravenous daptomycin or standard-of-care (SOC) treatment for up to 14 days.

The daptomycin was administered once daily, dosed by patient age. While the dosing was based on adult experience, researchers found that the younger the child, the more quickly their bodies eliminated daptomycin, so the pediatric doses increased as the age of the research participants decreased. Those aged 12 to 17 years received 5 mg/kg; 7 to 11 years, 7 mg/kg; 2 to 6 years, 9 mg/kg; and 12 to 23 months, 10 mg/kg.

“The safety and efficacy of intravenous daptomycin was comparable to standard-of-care IV antibiotics used for hospitalized children, usually vancomycin or clindamycin for MRSA and cefazolin for methicillin-susceptible strains of S. aureus,” said first author Dr. John Bradley, professor of clinical pediatrics, co-chief of the Division of Infectious Diseases at the University of California San Diego School of Medicine and director of the Division of Infectious Diseases at Rady Children’s Hospital-San Diego, in a press release from UC San Diego.

The most common adverse events seen were diarrhea (7% daptomycin, 5% SOC) and increased creatine phosphokinase (6% daptomycin, 5% SOC). The proportions of safety population patients with treatment-related adverse events were similar between the daptomycin (14%) and SOC (17%) groups.

Clinical success rates were also similar for the daptomycin and SOC groups.

“Daptomycin should provide a safe and effective alternative to vancomycin, clindamycin or linezolid for IV treatment of invasive MRSA skin infections,” said Dr. Bradley. “Concerns for vancomycin renal toxicity and clindamycin antibiotic resistance were not present. There was no evidence of daptomycin toxicity in the trial.”

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