Background The use of empiric antibiotics more selective than broad-spectrum antibiotics is very frequent, which entails increased resistance in our environment.
Purpose To evaluate the use of daptomycin in patients with suspected infection in complicated skin and soft-tissue infections (IPPBc), infectious endocarditis (EID) by meticilin resistant staphylococcus aureus (MRSA) or bacteremia by MRSA associated with EID or IPPBc.
Material and methods Prospective longitudinal intervention study. We collected data from patients with suspected IPPBc, EID or bacteremia with prescription of daptomycin who started the treatment with daptomycin between November 2017 and September 2018. Variables: age, sex, doses and days of treatment, use, antibiogram and treatment with statins (presenting risk of creatine kinase elevation and rhabdomyolysis). Data were collected using the Farmatools program, electronic prescribing and patient history Selene. The pharmaceutical interventions were perfomed for the improper use of daptomycin and interactions with statins.
Results Eighty-two patients were included (51.22% women, median age: 66.56). Doses of daptomycin: 4–10 mg/kg/day: average of treatment: 10.26 days. Justification of prescribing daptomycin: IPPBc (35.38%), EID (12.20%), bacteremia (51.23%) or others (1.19%). In 67 patients (81.71%) were empirical use, in 14 patients (17.10%) with indication by MRSA and without indication (Espondilocistitis) in one patient (1.19%). In 97.56%, the antibiogram was performed which revealed that 77.5% had no indication of daptomycin. Forty-seven patients changed to another more sensitive antibiotic, whereas 15 patients continued with daptomycin. Twenty patients had concomitant treatment with statins. Thirty-eight pharmaceutical interventions were made: 17 for no indication of daptomycin and 21 for interaction with statins. Of the total, 57.89% were accepted by the doctor (18.18% for no indication, 81.82% for interaction with statins). During the study, 47 patients suspended treatment with daptomycin and 35 patients continued with them (20 with indication, 15 without indication).
Conclusion In most cases, daptomycin was prescribed for empirical use, but the treatment was suspended after the antibiogram. Pharmaceutical interventions have helped to improve the use of daptomycin and contributed to reducing the risk of resistance in our environement. Futhermore, it is important to know the pharmacological interactions when establishing an antibiotic treatment to avoid the occurrence of adverse reactions.
References and/or acknowledgements No conflict of interest.
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