Daptomycin (IV)

Adjustment of Dose & Administration

Indication-Specific Adjustment

Indication	CrCl (mL/min)
	>30	10-30	<10, IHD	CRRT
Skin and soft tissue (complicated) Urinary tract infection (complicated)	4 mg/kg q24h	4 mg/kg q48h	6 mg/kg q48hr OR 4 mg/kg for 48hr inter-dialytic session AND 6 mg/kg for 72hr inter-dialytic session	4 mg/kg q48h
Bacteremia (non-S. aureus/enterococci) Intra-abdominal Febrile Neutropenia (empiric use for VRE colonization or history of VRE)	6 mg/kg q24h	6 mg/kg q48h	6 mg/kg q48hr OR 6 mg/kg for 48hr inter-dialytic session AND 8 mg/kg for 72hr inter-dialytic session	6 mg/kg q48h
Bacteremia (Staph aureus or vanc-susceptible enterococci) Bone and Joint Endocarditis	8 mg/kg q24h	8 mg/kg q48h	8 mg/kg q48hr OR 8 mg/kg for 48hr inter-dialytic session AND 10 mg/kg for 72hr inter-dialytic session	8 mg/kg q48h*
Vanc Resistant Enterococci bacteremia Invasive, refractory enterococcal infections Daptomycin SDD E. faecium	10 mg/kg q24h	10 mg/kg q48h	10 mg/kg q48hr OR 10 mg/kg for 48hr inter-dialytic session AND 12 mg/kg for 72hr inter-dialytic session	10 mg/kg q48h*

*Consider q24h dosing in CRRT for patients recieving effluent rates >30 mL/kg/hr or those not responding to standard dosing, with close CK monitoring

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Daptomycin Discharge Considerations for ID Consultants (more information about OPAT processes click here)

Clinical criteria to consider for OPAT daptomycin use:

Pathogens: Staphylococcus spp. (MRSA, MSSA, coagulase negative Staphylococcus)

Exclusion criteria:

Pulmonary infections

CNS infections

Infections with high risk of treatment resistance:

• Extensive vancomycin use beforehand, defined as >6 weeks of vancomycin with a likely persistent source of infection
• Insufficient source control

Steps for ID to fascilitate discharging on daptomycin:

• Use the “treatment teams” function to secure chat the primary team case manager and request a cost estimate for daptomycin vs vancomycin for OPAT.
• If approved for a switch, notify the primary team about plan to transition to daptomycin and request a first dose be administered inpatient.
• Add or update the treatment plan.

Renal Adjustment

See indication-specific dosing for creatinine clearance < 30 mL/min and hemodialysis

Serum Concentration Monitoring

Baseline and weekly monitoring of CK is suggested. More frequent CK monitoring may be considered in:

• On concomitant statin therapy (recommended to hold statin if possible during daptomycin therapy)
• Receiving high doses of daptomycin (>8 mg/kg/day)
• With morbid obesity and receiving >1200 mg/day
• With elevated baseline CK

Discontinue daptomycin if:

• Asymptomatic patients when CK >10x upper limit of normal (2000 IU/L)
• Symptomatic or sedated/non-verbal patients when CK >5x upper limit of normal (1000 IU/L)

 

Drug-Specific Information

• Pneumonia and Meningitis:  Avoid use!  Daptomycin is inactivated by lung surfactant and does not adequately cross the blood brain barrier.
• Daptomycin is NOT recommended for Corynebacterium spp. due to reported emergence of nonsusceptibility during therapy, including among isolates that are initially susceptible in vitro. If treatment is indicated, consider alternative thearpy. 
• Use total body weight (TBW) for non-obese (BMI <30).  In obese patients (BMI > 30), use Adjusted Body Weight (ABW).
• NOTE: E. faecium breakpoint of SDD refers to a breakpoint of </= 4 ug/mL.  Use dosing recommended in the table above.
• All daptomycin orders should be rounded to the nearest 50 mg in accordance with the dose-rounding protocol.
• Administer IV in saline or lactated ringer’s only.​

 

Restricted Use

ID consult is REQUIRED unless meeting exception criteria in Adult Febrile Neutropenia Guideline.

• If lung source is not suspected, daptomycin may be used Per Protocol for empiric treatment (up to 3 days) in Adult Febrile Neutropenia when +VRE colonization or personal history of VRE.

General Notes

1. Up-to-date cost information, click here 
2. IV antimicrobials outpatient (OPAT) dosing, click here
3. Obesity dosing weight recommendations here
4. Helpful drug-drug interaction check website here 
5. When dosing guidance is provided it is important to note the following:

Fixed (ie non weight-based) doses in adults are historically based on a 70 kg patient. Specific disease states or individual patients may warrant dosages that differ from the above recommendations. Since product-specific criteria for dose adjustment based on creatinine clearance exist, consult product information regarding specific recommendations for dosage adjustment based on estimated creatinine clearance.