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Dose-independent daptomycin associated rhabdomyolysis: Case report

Author(s): Metwali H* and Elder K

Background: Administration of Daptomycin may be associated with elevation in creatinine phosphokinase (CPK) level and increased risk of rhabdomyolysis with or without acute renal failure with a reported incidence of 2.8% in phase III clinical trials.

Case Presentation: We report the case of 70 years old male patient who had chronic vertebral osteomyelitis based on tissue (bone) culture, lumber spine MRI and abdominal CT. Daptomycin was started at a dose of 6 mg/kg intravenously once daily and continued at home thru Home Health Care (HHC) with baseline CPK=40 IU/L. After six days of treatment, CPK level elevated to 1254 IU/L. Despite initial improvement in CPK with reduction of Daptomycin dose, patient had to be re hospitalized again after 12 days of discharge with CPK level=15825 IU/L and acute kidney injury.

Conclusion: Daptomycin can be associated with elevations in CPK level and rhabdomyolysis despite reduction of dose. A baseline CPK level before starting Daptomycin treatment and more frequent monitoring in patients with additional risks, including renal impairment, is recommended.

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