Dosis superior a 6 mg/kg/día de daptomicina según parámetros farmacocinéticos/farmacodinámicos en infecciones por Staphylococcus aureus / Daptomycin dosing greater than 6 mg/kg/day depending on pharmacokinetic and pharmacodynamic parameters infections byStaphylococcus aureus

Daptomicina es un antibiótico lipopéptido cíclico cuya dosis autorizada es de 4 a 6 mg/Kg/día. Actualmente se debate la utilización de dosis mayores de daptomicina, en un rango de 8 a 12 mg/Kg/día, para el tratamiento de infecciones producidas por Staphylococcus aureus, justificado por su acción concentración dependiente y su perfil de tolerancia y seguridad, pero los estudios disponibles no son concluyentes. Se realiza una estratificación, por grupos de pacientes, de la recomendación de utilizar dosis superiores a 6 mg/Kg/día en función de los parámetros pk/pd predictores de eficacia y seguridad. Se concluye que dosis de 8 a 12 mg/Kg/día pueden ser beneficiosas en pacientes con sepsis grave, pacientes con hipoalbuminemia y en infecciones que conlleven una carga bacteriana potencialmente elevada o en las que se produzca un secuestro bacteriano. Sin embargo no es adecuado sobrepasar la dosis de 6 mg/Kg/día en pacientes con obesidad y/o con aclaramiento de creatinina inferior a 50 ml/min (AU)

Daptomycin is a cyclic lipopeptide antibiotic whose approved dose is 4 to 6 mg/kg/day. Today it is a matter of controversy the use of higher doses of daptomycin in a range of 8-12 mg/kg/ day, for the treatment ofStaphylococcus aureus infections, justified by its concentration-dependent action and its tolerability and safety profile, but the available studies are inconclusive. Stratification is performed by groups of patients, on the recommendation of using doses above 6 mg/kg/day based on the PK/PD parameters predictive of efficacy and safety. We conclude that doses of 8-12 mg/kg/day may be beneficial in patients with severe sepsis, patients with hypoalbuminemia and infections involving potentially high bacterial load or where there is a bacterial kidnapping. However it is not suitable exceed the dose of 6 mg/kg/day in patients with obesity and/or creatinine clearance less than 50 ml/min (AU)

[Daptomycin dosing greater than 6 mg/kg/day depending on pharmacokinetic and pharmacodynamic parameters infections by Staphylococcus aureus]. / Dosis superior a 6 mg/kg/día de daptomicina según parámetros farmacocinéticos/farmacodinámicos en infecciones por Staphylococcus aureus.

Daptomycin is a cyclic lipopeptide antibiotic whose approved dose is 4 to 6 mg/kg/day. Today it is a matter of controversy the use of higher doses of daptomycin in a range of 8-12 mg/kg/ day, for the treatment of Staphylococcus aureus infections, justified by its concentration-dependent action and its tolerability and safety profile, but the available studies are inconclusive. Stratification is performed by groups of patients, on the recommendation of using doses above 6 mg/kg/day based on the PK/PD parameters predictive of efficacy and safety. We conclude that doses of 8-12 mg/kg/day may be beneficial in patients with severe sepsis, patients with hypoalbuminemia and infections involving potentially high bacterial load or where there is a bacterial kidnapping. However it is not suitable exceed the dose of 6 mg/kg/day in patients with obesity and/or creatinine clearance less than 50 ml/min.

Daptomicina es un antibiótico lipopéptido cíclico cuya dosis autorizada es de 4 a 6 mg/Kg/día. Actualmente se debate la utilización de dosis mayores de daptomicina, en un rango de 8 a 12 mg/Kg/día, para el tratamiento de infecciones producidas por Staphylococcus aureus, justificado por su acción concentración dependiente y su perfil de tolerancia y seguridad, pero los estudios disponibles no son concluyentes. Se realiza una estratificación, por grupos de pacientes, de la recomendación de utilizar dosis superiores a 6 mg/Kg/día en función de los parámetros pk/pd predictores de eficacia y seguridad. Se concluye que dosis de 8 a 12 mg/Kg/día pueden ser beneficiosas en pacientes con sepsis grave, pacientes con hipoalbuminemia y en infecciones que conlleven una carga bacteriana potencialmente elevada o en las que se produzca un secuestro bacteriano. Sin embargo no es adecuado sobrepasar la dosis de 6 mg/Kg/día en pacientes con obesidad y/o con aclaramiento de creatinina inferior a 50 ml/min.

Percutaneous catheter drainage of tuberculous psoas abscesses.

Six patients with 7 tuberculous psoas or ilio-psoas abscesses were treated by CT-guided catheter drainage and chemotherapy. The abscesses (5 unilateral and 1 bilateral) were completely drained using a posterior or lateral approach. The abscess volume was 70 to 700 ml (mean 300 ml) and the duration of drainage 5 to 11 days (mean 7 days). Immediate local symptomatic improvement was achieved in all patients, and there were no procedural complications. CT follow-up at 3 to 9 months showed normalization in 5 patients, 2 of whom are still on medical therapy. One patient, who did not take the medication regularly, had a recurrent abscess requiring new catheter drainage after which the fluid collection disappeared. Percutaneous drainage represents an efficient and attractive alternative to surgical drainage as a supplement to medical therapy in the management of patients with large tuberculous psoas abscesses.