臨床藥物治療學 Therapeutics of Clinical Drugs MRSA vancomycin 1 g 60 Q12H MRSA vancomycin 12 (6 2 ) 37.4 Visual Analogue Scale /mm 3 eosinop

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1 Therapeutics of Clinical Drugs 臨床藥物治療學 Daptomycin 用於細菌性骨關節炎之案例報告健仁醫院藥劑科藥師蕭詩如吳企華健仁醫院醫師王堯顯摘要 Daptomycin cyclic lipopeptide (concentration-dependent killing) methicillin-resistance Staphylococcus aureus (MRSA) FDA Staphylococcus aureus 56 MRSA vancomycin teicoplanin daptomycin daptomycin daptomycin methicillin-resistance Staphylococcus aureus MRSA 壹前言 10 % 1 Staphylococcus aureus 4 0 % β-hemolytic streptococci Streptococcus pneumoniae 2 貳案例報告 56 (chondromalacia of patella) /mm 3 ( 4-10*10 3 /mm 3 ) C-reactive protein (CRP) 0.62 mg/l ( < 0.5 mg/l) ESR 22 mm/h ( < 15 mm/h) 12167/mm 3 ( <200/mm 3 ) 99% ( < 25%) 藥學雜誌第 107 冊 63

2 臨床藥物治療學 Therapeutics of Clinical Drugs MRSA vancomycin 1 g 60 Q12H MRSA vancomycin 12 (6 2 ) 37.4 Visual Analogue Scale /mm 3 eosinophil 7.5 (<7%) 6 3 vancomycin teicoplanin teicoplanin daptomycin 500 mg QD ( 4-6 mg/kg/day75 kg) 6 16 fucidic acid 500 mg BID rifampin 300 mg BID 6 18 表一用藥紀錄 5/19 5/27 6/1 6/2 6/3 6/5 6/15 6/16 8/2 Vancomycin 1 g q12h IV Fosfomycin 2 g q6h IV Teicoplanin 600 mg qd IV Daptomycin 500 mg qd IV Rifamycin 300 mg bid PO Fucidin acid 500 mg bid PO Cetirizine 10 mg hs PO Vena-Ca-B6 5 ml tid IV Dexamethasone 10 mg stat IV 參討論 ( 4-6 ) S.aureus MRSA 53-83% 4 M R S A v a n c o m y c i n vancomycin S.aureus vancomycin VISA (vancomycin- intermediate staphylococcus aureus) VRSA (vancomycinresistance staphylococcus aureus) 5,6 MRSA vancomycin 7 7 表二細菌性骨關節炎起始經驗性抗生素之建議 MRSA MRSA Oxacillin 2 g q4h or Cefazolin 2 g q8h Vancomycin 1 g q12h 64 THE JOURNAL OF TAIWAN PHARMACY Vol.27 No.2

3 Daptomycin glycopetide (vancomycin teicoplanin) MRSA MRSA FDA daptomycin linezolid tigecycline 6,8 ㄧ Linezolid Ceftriaxone 1 g q24h Ceftazidime or cefepime 2 g q8h, Piperacillin-tazobactam 4.5 g q6h or carbapenem ceftazidime fluoroquinolone aminoglycoside Linezolid oxazolidinones 50S23S RNA Linezolid VRE (vancomycin resistant enterococcus) MRSA VISA VRSA FDA (Complicated skin and skin structure infections, csssis) ( MRSA) ( MRSA) VRE 100% linzolid 14 linezolid 2 linezolid 6,8 linezolid 2006 Senneville E linezolid linezolid 4 (n=66) MRSA (68%) 13 (5-36 )6-8 linezolid mg BID 78.5% rifampin (48.5%) 56 (84.8%) % 51.5% 21 (31.8%) 6 (9.1%) 34.8% 9 二 Tigecycline Tigecycline glycylcyclines VRE MRSA penicillinresistant Streptococcus pneumoniae (Chlamydia pneumoniae, Mycoplasma pneumoniae) 6, % 2% 6,8 Tigecycline 三 Daptomycin Daptomycin Streptomyces roseos- 藥學雜誌第 107 冊 65

4 臨床藥物治療學 Therapeutics of Clinical Drugs porus DNA RNA linezolid MRSA VISA VRSA VRE Staphylococcus aureus Daptomycin mg/kg QD 30 ml/min 30 Clcr < 30 min/ml 48 4 mg/kg Daptomycin (creatine phosphokinase) Daptomycin (case series) 53 81% (43/53) (23 43%) ( %) MRSA ( %) Daptomycin 4-6 mg/kg/day daptomycin daptomycin 2 CPK 10 The Cubicin Outcome Registry and Experience (CORE) multiple centre daptomycin ( ) Forrest GN daptomycin 22 55% (36%) S.aureus (64%) 22 rifampin (43%) (response rate) 9 (41%) 11 (50%) 91% daptomycin 2 (84%) 11 daptomycin daptomycin 肆結論 S.aureus Vanomycin glycopetide linezolid daptomycin tigecycline MRSA daptomycin 66 THE JOURNAL OF TAIWAN PHARMACY Vol.27 No.2

5 Daptomycin vancomycin teicoplanin daptomycin 500 mg 12 doptomycin glycopetide 參考資料 : 1. Mathews CJ, Coakley G: Septic arthritis: current diagnostic and therapeutic algorithm. Current opinion in rheumatology 2008; 20(4): Forrest GN, Donovan BJ, Lamp KC, et al: Clinical experience with daptomycin for the treatment of patients with documented gram-positive septic arthritis. The Annals of pharmacotherapy 2008; 42(2): Trissel LA: Handbook on Injectable Drugs,15 th ed. Wisconsin, ASHP, 2009: Hsueh PR, Liu CY, Luh KT: Current status of antimicrobial resistance in Taiwan. Emerging infectious diseases 2002; 8(2): Rice DA, Mendez-Vigo L: Daptomycin in bone and joint infections: a review of the literature. Archives of orthopaedic and trauma surgery 2009; 129(11): Lentino JR, Narita M, Yu VL: New antimicrobial agents as therapy for resistant gram-positive cocci. Eur J Clin Microbiol Infect Dis 2008; 27(1): OHL CA: Infectious arthritis of native joints. In: Mandell GL, Bennett JE, Dolin R. Principles and practice of infectious disease,6th ed. Philadelphia. Elsevier, 2005: Stryjewski ME, Corey GR: New treatments for methicillin-resistant Staphylococcus aureus. Current opinion in critical care 2009; 15(5): Senneville E, Legout L, Valette M, et al: Effectiveness and tolerability of prolonged linezolid treatment for chronic osteomyelitis: a retrospective study. Clinical therapeutics 2006; 28(8): Falagas ME, Giannopoulou KP, Ntziora F, et al: Daptomycin for treatment of patients with bone and joint infections: a systematic review of the clinical evidence. International journal of antimicrobial agents 2007; 30(3): Stengel D, Bauwens K, Sehouli J, et al: Systematic review and meta-analysis of antibiotic therapy for bone and joint infections. The Lancet infectious diseases 2001; 1(3): Daptomycin Treatment in A Patient with Septic Arthritis Shih-Ju Hsiao 1, Chi-Hua Wu 1, Jao-Hsien Wang 2 Department of pharmacy, Jiannren Hospital, Kaohsiung, Taiwan 1 Division of infection disease, Department of Internal Medicine, Jiannren Hospital, Kaohsiung, Taiwan 2 Abstract Daptomycin is a cyclic lipopeptide with concentration-dependent killing and bactericidal against Gram-postive cooci including MRSA. The drug was approved by the Food and Drug Administration (FDA) for the treatment of complicated skin and skin structure infections and Staphylococcus auerus bacteremia including right-sided endocarditis. We report a 56-yearold male was diagnosed with septic arthritis due to MRSA. Vancomycin and teicoplanin therapy for the patient was terminated due to allergy and change to daptomycin. In this article we performed a review of literature to evaluate the effectiveness and safety of daptomycin therapy in septic arthritis. 藥學雜誌第 107 冊 67

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ºî½×2-p174-184 174 美國感染症醫學會 Methicillin 抗藥性金黃色葡萄球菌治療指引李倩瑜 1 鄭舒倖 2 行政院衛生署桃園醫院 1 小兒科 2 感染科 (IDSA) 2011 methicillin (methicillin-resistant Staphylococcus aureus; MRSA) (practice guidelines)[1]