Previous studies and the concentration-dependent antibacterial actions of daptomycin suggested that a high dose would be needed for difficult-to-treat infections in burn patients. Here, we evaluated the effects of administration of low and high doses of daptomycin in patients with severe burn injuries. The study retrospectively analyzed 10 patients with severe burn injuries, using pharmacokinetic (PK) and pharmacodynamic (PD) evaluations of daptomycin doses given to combat serious infections. Daptomycin was administered as a single dose or by multiple doses intravenously at a standard dose of 6 mg/kg/d or a high dose of 12 mg/kg/d for 7 to 14 days. The serum concentrations of daptomycin from patients were analyzed by liquid chromatography–mass spectrometry/mass spectrometry (LC-MS/MS). Burn injury patients treated with high-dose daptomycin had a linear PK profile and a negative correlation between the AUC0–24 and Baux score (R2 = .953 and R2 = .801). The Cmax, AUC0–24, and t(h)½ increased significantly compared with patients given a standard dose. The efficacy of daptomycin against Staphylococcus aureus showed significantly higher rates of (AUC0–24)/MIC and Cmax/MIC after high-dose daptomycin compared with the standard dose, reflected in a significant correlation between a high dose and the Baux score (r = .976, P < .001). Positive S. aureus cultures from two of three high-dose and none of two daptomycin low-dose patients converted from positive to negative after therapy. No serious adverse events or discontinuation of the drug occurred during the treatment period. Daptomycin doses up to 12 mg/kg/d were well tolerated in Chinese patients with severe burn injuries, which were complicated by infections with S. aureus.

IntroductionTetanus is a fatal infectious disease. It could cause typical signs like pain, headache, stiffness, and spasms of facial muscles as well as trunk and skeletal muscles. The symptoms are risus sardonicus, trismus and opisthotonus. How to control the spasticity and rigidity of muscles is still a problem. Our object is to raise the feasibility of titration of high dose sedatives in the management of severe tetanus.Case presentationA 37-year-old woman was sustained a 2 cm wound in the right anterior part of chest. Then she developed progressive risus sardonicus, trismus and opisthotonus, elevated liver enzymes, creatine kinase, lactic acid and myoglobin. The patient was treated with continuous infusion of propofol (50-100 mg/h, 22 days) and midazolam (5-20 mg/h, 37 days) for sedation, vecuronium (1-6 mg/h, 25 days) for muscle relaxation. The symptoms of tetanus were controlled, and there were no side-effects appeared.ConclusionWe report one case of severe tetanus. In this case, several types of sedative were administrated and most of them were high doses. The patient recovered while no complications remained. This case report indicated that combination and high dose of sedation for severe tetanus were feasible. We recommend this treatment as the guidance of similar patients.