A case report and literature review of daptomycin-induced liver injury.

Daptomycin is a lipopeptide antimicrobial used to treat gram positive organisms including multi-drug resistant infections. It has been shown to occasionally cause abnormalities in liver function but more commonly is associated with elevations in serum creatinine phosphokinase (CK) (Hair and Keam, 2007) [1]. We describe a case where a patient being treated for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia with daptomycin developed asymptomatic elevated transaminases without evidence of multiorgan failure, hyperbilirubinemia or elevation of CK levels. Other etiologies for liver injury were considered and ruled out, and after daptomycin was discontinued, the transaminases returned to normal levels. We also provide a review of other cases to date documenting possible cases of daptomycin-induced liver injury.

Blood pressure measurement in the geriatric population.

As the population above 60 years of age is the fastest growing and hypertension is highly prevalent in this group, accurate blood pressure (BP) measurement in the elderly is a very important and widely applicable subject. As with any other population, an accurate measurement of BP is essential to plan therapy and this remains an important consideration in the elderly as well. There are some unique problems of BP measurement in the elderly, including drug-induced orthostatic hypotension, white-coat hypertension, and advanced atherosclerotic disease with stiff arteries. For clinical use, home blood pressure monitoring (HBPM), office measurement, and ambulatory blood pressure monitoring all play a role in patient management. In the office setting, aneroid devices, hybrid devices with electronic transducers, and oscillometric devices are available; all of these require frequent calibration, well-trained operators and technically sound execution. Because the white-coat effect is common in this group, there is a good case for the use of HBPM, which could also be used to detect orthostatic changes at home. Also, HBPM predicts cardiovascular events better than clinical BP, and is also useful in monitoring treatment. Ambulatory blood pressure monitoring provides the most precise assessment of BP over an extended period, but is more complex and expensive. Finally, the utility of noninvasive central arterial pressure through radial artery applanation tonometry, especially in patients with resistant hypertension and likely in the elderly because of advanced atherosclerotic disease and stiff arteries, may prove to be a useful tool to guide or modify drug therapy in the future and requires further study.