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Open Access Highly Accessed Case report

High-dose daptomycin and fosfomycin treatment of a patient with endocarditis caused by daptomycin-nonsusceptible Staphylococcus aureus: Case report

Liang-Yu Chen, Cheng-Hsiung Huang, Shu-Chen Kuo, Chen-Yuan Hsiao, Mei-Lin Lin, Fu-Der Wang* and Chang-Phone Fung

BMC Infectious Diseases 2011, 11:152  doi:10.1186/1471-2334-11-152

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Fosfomycin therapy for difficult-to-treat MRSA infection

Amorn Leelarasamee   (2011-11-03 08:08)  Mahidol University email

Dear Sir,
I would like to congratulate the authors for reporting this useful and stimulating case and the journal for publishing the case report.1 I and some ID physicians in Thailand have been using fosfomycin for quite long time to treat infections due to MRSA.
My comment is that the high impact-factor journal does not mention the use of fosfomycin for MRSA infection even if the infection due to MRSA fails to respond to vancomycin or daptomycin.2,3 So the report of this case provides an useful option to help global physicians in solving the problem of difficult-to-treat MRSA infections.
My questions for this case are the method of intravenous administration of fosfomycin 6 gm every 6 hours for 56 days and its adverse reaction. My experience with this high daily dose and long duration of treatment is that the patient would eventually experience thrombophlebitis and hypernatremia with subsequent leg edema if sodium intake is not severely restricted. Did the authors encounter these side effects in this case?. Did the authors use 5% dextrose in water for dissolving fosfomycin for intravenous infusion?. If the authors could report the duration of each intravenous fosfomycin infusion and the vein used for the infusion in this case, it would greatly benefit other patients who may need this kind of antimicrobial treatment in the future.
Amorn Leelarasamee, M.D.
Professor of Medicine and Infectious Disease
Faculty of Medicine Siriraj Hospital
Mahidol University
Thailand

References
1. Chen et al. BMC Infectious Diseases 2011 11:152 doi:10.1186/1471-2334-11-152
2. Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the Treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis 2011;52:1–38
3. Ben M Lomaestro. Vancomycin dosing and monitoring 2 years after the guidelines. Expert Rev Anti Infect Ther 2011;9(6):657-667

Competing interests

None

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