minocycline and Renal-Insufficiency

The pharmacokinetic parameters of tigecycline were assessed in subjects with severe renal impairment (creatinine clearance <30 mL/min, n = 6), subjects receiving hemodialysis (4 received tigecycline before and 4 received tigecycline after hemodialysis), and subjects with age-adjusted, normal renal function (n = 6) after administration of single 100-mg doses. Serial serum and urine samples were collected and assayed using validated liquid chromatography with tandem mass spectrometer (LC/MS/MS) methods. Concentration-time data were then analyzed using noncompartmental pharmacokinetic methods. Tigecycline renal clearance in subjects with normal renal function represented approximately 20% of total systemic clearance. Tigecycline clearance was reduced by approximately 20%, and area under the tigecycline concentration-time curve increased by approximately 30% in subjects with severe renal impairment. Tigecycline was not efficiently removed by dialysis; thus, it can be administered without regard to timing of hemodialysis. Based on these pharmacokinetic data, tigecycline requires no dosage adjustment in patients with renal impairment.

Topics: Adult; Aged; Anti-Bacterial Agents; Female; Humans; Kidney; Male; Middle Aged; Minocycline; Renal Dialysis; Renal Insufficiency; Tigecycline

Daptomycin is licensed in adults for the management of Staphylococcus aureus methicillin-resistant infections, including bone and skin complicated infections. We describe for the first time its use in a renal transplant recipient for Fabry-Anderson Disease with right heel osteomyelitis. The patient was unresponsive to first-line Teicoplanin and second-line Tigecycline, whereas he was successfully treated with third-line Daptomycin monotherapy at 4 mg/Kg/qd for 4 weeks. Local debridement was performed in advance of each line of treatment.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents; Calcaneus; Daptomycin; Fabry Disease; Heel; Humans; Kidney Transplantation; Male; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus; Metronidazole; Minocycline; Osteomyelitis; Renal Insufficiency; Salvage Therapy; Staphylococcal Infections; Teicoplanin; Tigecycline; Tomography, X-Ray Computed