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Vol. 30. Núm. S1.
Daptomicina en las infecciones causadas por bacterias grampositivas
Páginas 38-42 (Febrero 2012)
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Vol. 30. Núm. S1.
Daptomicina en las infecciones causadas por bacterias grampositivas
Páginas 38-42 (Febrero 2012)
DOI: 10.1016/S0213-005X(12)70070-8
Acceso a texto completo
Daptomicina en el tratamiento de las infecciones por grampositivos en pacientes con insuficiencia renal crónica
Daptomycin in the treatment of Gram-positive infections in patients with chronic renal failure
Visitas
4466
Cristina Sarriá Cepeda
Servicio de Medicina Interna-Infecciosas, Hospital de la Princesa, Madrid, España
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Visitas
Información del artículo
Resumen

La daptomicina es un lipopéptido cíclico, eficaz en el tratamiento de las infecciones causadas por bacterias grampositivas, incluyendo las multirresistentes. Es rápidamente bactericida y escasamente nefrotóxica. Los pacientes con insuficiencia renal grave presentan una disminución en su aclaramiento y un aumento de la semivida de eliminación plasmática. La dosificación recomendada en pacientes con aclaramiento de creatinina (ClCr) < 30ml/min en la infección de piel y tejidos blandos es de 4mg/kg/48h y de 6mg/kg/48h en la bacteriemia y la endocarditis derecha. Estudios farmacocinéticos y datos del registro CORE han permitido mejorar la dosificación de la daptomicina en los pacientes en tratamiento con hemodiálisis, diálisis peritoneal u otras técnicas de depuración externa. Los pacientes con ClCr < 30ml/min tienen unas tasas de eficacia que oscilan entre el 69,2 y el 96%, siendo éstas similares o inferiores a las observadas en pacientes con ClCr > 30ml/min. Los pacientes en hemodiálisis pueden tener unas tasas más altas de fracaso clínico. Se exponen los resultados preliminares del EUCORE en el ámbito español. La presencia de insuficiencia renal al comienzo del tratamiento con daptomicina no se asoció con un incremento en las tasas de efectos adversos graves. Daptomicina es un antibiótico con buen perfil de eficacia clínica y seguridad para el tratamiento de infecciones en pacientes con insuficiencia renal crónica. Consensos de diferentes sociedades han incorporado la utilización de daptomicina en el tratamiento de la bacteriemia por Staphylococcus aureus resistente a meticilina en pacientes con insuficiencia renal.

Palabras clave:
Daptomicina
Insuficiencia renal
Diálisis
Farmacocinética
Abstract

Daptomycin is a cyclic lipopeptide that is effective in the treatment of Gram-positive infections, including those caused by multiresistant pathogens. This drug has rapid bactericidal action and low nephrotoxicity. Patients with severe renal failure show a dicrease in its renal clearance and an increase in the elimination half-life. The recommended dose in patients with creatinine clearance (CrCl) < 30ml/min is 4mg/kg/48h in skin and soft tissue infections and is 6mg/kg/48h in bacteremia and right endocarditis. Pharmacokinetic studies and data from the CORE Registry have allowed improved the dosing regimen in patients under hemodialysis, peritoneal dialysis and other extrarenal depuration techniques. Patients with a CrCl < 30ml/ min have rates of efficacy ranging between 69.2% and 96%, these rates being similar to or lower than those observed in patients with a CrCl > 30ml/min. Patients under hemodialysis may have higher rates of clinical failure. This article presents the preliminary results of the EUCORE in Spain. The presence of renal failure at the start of daptomycin therapy is not associated with an increase in the rates of severe adverse effects. Daptomycin has a good safety and efficacy profile for the treatment of infections in patients with chronic renal insufficiency. The consensus documents of distinct societies have incorporated the use of daptomycin in the treatment of bacteremia due to methicillin-resistant Staphylococcus aureus in patients with renal insufficiency.

Keywords:
Daptomycin
Renal insufficiency
Dialysis
Pharmacokinetics
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Copyright © 2012. Elsevier España S.L.. Todos los derechos reservados
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