Daptomycin associated acute eosinophilic pneumonia

KUANG Jun-jian; LU Mei

Abstract：Objective:To investigate the clinical features, causes and therapeutic measures of daptomycin associated acute eosinophilic pneumonia (AEP).Methods:Literature about AEP induced by daptomycin published in foreign language from 2005 to May 2015 was collected by retrieving PubMed database. The baseline characteristics of patients, the dosage and administration of daptomycin, the clinical manifestations and imaging performance, onset time, the outcome of treatment and prognosis of the AEP were analyzed.Results:There were totally 27 patients (23 men and 4 women) suffered from daptomycin associated AEP in 13 case reports. The average age was 64. Most administration dose ranged from 4.4 to 8.0 mg·kg-1·d-1. The median onset time of daptomycin associated AEP was 14 days after administration and the median time of recovery was 2 days. Fever and dyspnoea were the main clinical symptoms of AEP induced by daptomycin. About 66.67% of patients had higher number of eosinophilic granulocyte in alveolar lavage fluid eosinophils. Most CT scan of the patients showed bilateral inifltrates and ground glass consolidation. After withdrawal and symptomatic treatment, the symptoms eliminated quickly. Among 27 patients, 17 patients were cured and 10 patients were getting better.Conclusion:Daptomycin can rarely cause AEP. The dosage seems to have nothing to do with daptomycin associated AEP. The physiopathologic mechanism of AEP is considered to be involved in the immunological reactions. Eosinophils migrated to alveoli through various mechanisms. So the symptom usually comes out within more than 1 week after administration. If AEP is considered to be caused by daptomycin, prompt withdrawal is necessary. The management of AEP induced by daptomycin includes administration of oxygen, glucocorticoid, mechanical ventilation and other symptomatic treatments. It is very important to be aware of daptomycin associated AEP as early as possible during the therapeutic process.