Daptomycin dosing based on ideal body weight versus actual body weight: comparison of clinical outcomes.
Antimicrob Agents Chemother. 2013 Oct 21;
Authors: Ng JK, Schulz LT, Rose WE, Fox BC, Andes DR, Buhr KA, Fish JT
Daptomycin use at our institution changed to ideal body weight dosing based on a published analysis of pharmacokinetic-pharmacodynamic efficacy target attainment, bacterial ecology, and a desire to reduce drug toxicity. The current study compared outcomes between actual body weight and ideal body weight dosing of daptomycin before and after this intervention. In the evaluable group, sixty-nine patients received doses based on actual body weight and 48 patients received doses based on ideal body weight. Patients were treated for documented Enterococcus sp, Staphylococcus aureus, or coagulase-negative Staphylococcus infections, including: bloodstream, intra-abdominal, skin and soft tissue, urinary, and bone. There was no statistically significant difference in clinical success between the groups (actual body weight 88.9% vs. ideal body weight 89.1%, p=0.97). After adjusting for gender, age, body mass index, concomitant HMG-CoA reductase inhibitors, infection type, and organism type, clinical success rates remained similar between groups (adjusted odds ratio=0.68 in favor of actual body weight, 95% CI 0.13-3.55). Microbiological outcomes, length of stay, mortality, and adverse effects were also similar between groups. Further studies are warranted to confirm that ideal body weight provides similar outcomes to actual body weight dosing for all patients and types of infections and organisms.
PMID: 24145531 [PubMed - as supplied by publisher]