Daptomycin safe, effective for serious paediatric skin infections
Daptomycin is safe and effective for treating complicated skin and skin structure infections (cSSSI) in children compared with standard-of-care (SOC), a recent study has shown.
An evaluator-blind trial was conducted on 389 children aged 1–17 years who had serious gram-positive skin infections which required hospitalization (ie, cellulitis and major abscesses). Over 40 percent of the infections were caused by methicillin-resistant Staphylococcus aureus (MRSA). [Pediatrics 2017;doi:10.1542/peds.2016-2477]
Participants were randomized to daptomycin (n=256) or SOC (n=133: 67 on clindamycin and 56 on vancomycin) treatment for ≤14 days. Daptomycin dose was once daily and stratified by four age cohorts (ie, 12–17 years, 5 mg/kg; 7–11 years, 7 mg/kg; 2–6 years, 9 mg/kg; and 12–23 months, 10 mg/kg).
Favourable treatment responses were noted in both daptomycin and SOC treatment arms (91 percent and 87 percent) with partial or complete resolution of cSSSI signs and symptoms at test-of-cure (7–14 days after the last dose).
Overall therapeutic success rates were similar in both daptomycin and SOC treatment arms (97 percent and 98.7 percent) at test-of-cure.
Failure rates were low in both treatment arms, with only two clinical and two microbiological failures established at test-of-cure.
Most treatment-emergent adverse events reported were mild in intensity, with diarrhoea and increased blood creatine phosphokinase (CPK) as the most common in both treatment arms.
“In adults, daptomycin has the potential to cause CPK elevations, in particular at the higher doses used to treat bacteraemia. In our study, increased CPK was not more frequent in daptomycin- than in SOC-treated children, suggesting there is no need to proactively monitor for clinical or laboratory evidence of muscle toxicity when using daptomycin in paediatric patients at the doses studied,” said the researchers.
While daptomycin is only approved for adult use, and given the likelihood of renal function deterioration with higher vancomycin doses and in cases of high clindamycin resistance, these findings suggest that daptomycin is a suitable alternative to clindamycin or vancomycin for MRSA or methicillin-susceptible Staphylococcus aureus therapy in the paediatric setting, noted the researchers.
Furthermore, the once-daily daptomycin dosage enables outpatient parenteral therapy, offering a more practical advantage over clindamycin or vancomycin, which is administered every 6–8 hours in paediatric patients, they added.
Aside from the absence of renal abnormalities, the researchers found no association between daptomycin use and increased risk of muscular or neurologic toxicity, which was consistent with previous safety studies. [Pediatr Infect Dis J 2011;30:712-714; Pediatr Infect Dis J 2008;27:330-334; Pediatr Infect Dis J 2014;33:936-939]