Daptomycin Policy

Antimicrobial prescribing: NHS Forth Valley
NHS Forth Valley

Dosing guidelines for Daptomycin

Daptomycin should only be used on the advice of an infection specialist (micro or ID consultant)

Daptomycin Indications and Dosing

Indications

Dose

Complicated skin and soft tissue infection (cSSTI) without Staphylococcus aureus bacteraemia

Licensed dose is 4mg/kg but in practice some centres use off-label 6mg/kg 

cSSTI with Staphylococcus aureus bacteraemia

6mg/kg 24 hourly

**Bone and joint infection

OR

Bacteraemia (excluding Enterococcal organisms)

8-10 mg/kg* 24 hourly

**Endocarditis (NVE & PVE) OR

Enterococcal bacteraemia

10-12 mg/kg* 24 hourly

 

*Use total body weight total body weight (TBW) or adjusted body weight (AdjBW) if BMI >30

** Off-label indication

 

AdjBW equation (if BMI >30)

AdjBW = (0.4 x (TBW – IBW)) + IBW

 

Rounding of doses

  • Where possible use whole vials (350mg and 500mg vial strengths are available).
  • If the calculated dose is ≤ 10% above the available whole vial round the dose down 
  • Dose rounding may result in a higher mg/kg dose than recommended. Doses over 12mg/kg are not recommended. Discuss with pharmacy if the dose is unclear.

 

Dose adjustments in renal impairment

Renal function

(Creatinine clearance (CrCl))

Dose adjustment

< 30 ml/min

OR

irregular or daily haemodialysis

Reduce frequency to 48 hourly and more frequent monitoring is required – consider therapeutic drug monitoring if long course is required. Discuss with pharmacy.

Regular 3x weekly haemodialysis

Give on haemodialysis days only (after haemodialysis)

Monitoring requirements while on daptomycin

Baseline Bloods:

Urea and Electrolytes

LFTs

CRP

FBC

Creatine phosphokinase (CK)

 

Minimum weekly thereafter:

Urea and Electrolytes, LFTs, CRP, FBC, CK (2-3 times weekly if poor renal function or receiving RRT)

For patients on higher doses consider more frequent monitoring

Patients must be advised to report muscle pain

Monitor for breathlessness or new cough as this may indicate eosinophilic pneumonitis (Note not usually associated with peripheral blood eosinophilia)

Daptomycin should be discontinued if:

Symptomatic rise in CK observed (especially if CPK is more than 5 times upper normal limit)

Therapeutic Drug Monitoring:

Routine daptomycin therapeutic drug monitoring is not recommended. However, daptomycin trough concentrations may be useful in patients requiring renal replacement therapy to predict toxicity on longer courses. 

Editorial Information

Author email(s): euan.proud3@nhs.scot.