Daptomycin-induced eosinophilic pneumonia - a systematic review

Abstract

PurposeEosinophilic pneumonia comprises a group of lung diseases in which eosinophils appear in increased numbers in the lungs and sometimes in the bloodstream. Several case reports link daptomycin use to this phenomenon.SummaryWe performed a systematic literature review to identify cases of eosinophilic pneumonia associated with daptomycin use. Relevant studies were identified by searching Pubmed/Medline, EMBASE, Google Scholar, Cochrane Database of Systematic Reviews, and Clin-Alert from inception to May 2016, and manual searches of reference lists. All case reports that include information regarding patient age, indication, clinical and objective findings, treatment and outcome were evaluated. Abstracts from conference proceedings as well as case reports not in English were excluded. Descriptive statistics were used to analyze the data. Thirty-five patient-cases were included in the final analysis. Patients most likely to be identified with daptomycin-induced eosinophilic pneumonia were male (83%) and elderly (mean age 65.4 ± 15 years). The dose for daptomycin ranged from 4 to 10 mg/kg/day, but included a large number of patients with renal dysfunction. The average duration of daptomycin therapy upon onset of EP symptoms was 2.8 ± 1.6 weeks. Majority of patients presented with dyspnea (94%), fever (57%) and were also found to have peripheral eosinophilia (77%) and infiltrates/opacities of CT/CXR (86%). Symptom improvement was seen after daptomycin discontinuation (24 h to 1 week). The majority of patients were also prescribed treatment with corticosteroids (66%).ConclusionClinicians should be aware of daptomycin-induced eosinophilic pneumonia and its symptoms along with its presentation and treatment.

Acute Eosinophilic Pneumonia: A Rare Complication of Daptomycin Therapy

“…AEP may be difficult to recognize due to its delayed presentation. One systematic review found the mean duration of daptomycin therapy prior to the development of symptoms to be 2.8 ± 1.6 weeks, with one study reporting presentation of symptoms as late as 6 weeks into therapy [9,12]. In the presented case, the patient became symptomatic after 2 weeks of daptomycin therapy and met all diagnostic criteria as established by the FDA.…”

“…In the case of daptomycin-induced AEP, it is thought that the accumulation of the drug within a pulmonary surfactant plays a key role in the induction of an inflammatory reaction [6]. In reported cases, dosing is significantly varied, suggesting that the development of AEP may occur at any dose, however, among patients who develop AEP, those receiving higher doses had a shorter time to develop [6,9]. Additionally, elevated serum concentration due to chronic kidney disease may play a role in some cases, although a correlation between serum levels of daptomycin, and accumulation within pulmonary surfactant has not been definitively established [6].…”

“…Solomon and Schwarz have additionally proposed diagnostic criteria, but require reintroduction of daptomycin to demonstrate recurrence of eosinophilic pneumonia upon rechallenge, but this is not advised due to risk to the patient [8]. In addition to the diagnostic criteria, many patients present with peripheral eosinophilia, although this is only present in approximately 77% of patients, and therefore, is not required for diagnosis [9]. AEP may be difficult to recognize due to its delayed presentation.…”

“…Multiple diagnostic criteria have been established, including one by the FDA and another by Solomon and Schwarz [7][8]. Treatment involves cessation of the drug, and in a majority of cases, intravenous steroids [6,9]. We present a case of this rare complication of daptomycin therapy.…”

Daptomycin associated eosinophilic pneumonia: case report and differential diagnoses

“…Corticosteroid is believed to rapidly reverse the inflammation and thereby improve the hypoxia [8]. Patients are usually started on intravenous methylprednisone 60–125 mg every 6–8 h, transitioned to oral prednisone 40–60 mg daily with clinical improvement and is tapered over 2–6 weeks to avoid relapse [8,10]. …”