# A Case of Confusion in an Obese Patient Treated With Daptomycin: Neurotoxicity

## TL;DR

A 73-year-old obese man experienced confusion likely caused by high daptomycin levels, highlighting the need for caution in dosing this antibiotic in obese patients.

## Contribution

This case report highlights a rare instance of daptomycin-induced neurotoxicity in an obese patient and suggests dose adjustments may be necessary.

## Key findings

- The patient developed confusion and spatial disorientation on the fifth day of daptomycin treatment.
- High serum daptomycin concentrations were observed, suggesting a link to neurotoxicity.
- Neurological symptoms resolved after discontinuing the drug.

## Abstract

Daptomycin (DAP) is a cyclic lipopeptide antibiotic with bactericidal activity against gram-positive bacteria. The most common adverse reaction is myotoxicity characterized by rhabdomyolysis. Other reported adverse reactions include gastrointestinal symptoms, skin lesions, bleeding, and pulmonary involvement. Neurotoxicity is rare and its mechanism remains partially elucidated. We report a case of confusion consistent with DAP-induced neurotoxicity. A 73-year-old obese man was treated with DAP 9 mg/kg for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia associated with foot osteitis and cervical posterior inter-apophyseal arthritis. On the fifth day of treatment, he developed spatial disorientation, and serum DAP concentrations were very high. DAP-induced neurotoxicity was suggested. His neurological status returned to normal after treatment was stopped. This observation describes a relationship between confusion and DAP that is favored by obesity. Clinicians should be alert for neurologic disorders associated with DAP. It is prudent to reduce doses in obese patients.