title: Daptomycin dosing based on ideal body weight versus actual body weight: comparison of clinical outcomes.
abstract: 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, 69 patients received doses based on actual body weight and 48 patients received doses based on ideal body weight. Patients were treated for documented Enterococcus species, Staphylococcus aureus, or coagulase-negative Staphylococcus infections, including bloodstream, intraabdominal, skin and soft tissue, urinary, and bone. There was no statistically significant difference in clinical success between the groups (88.9% for actual body weight compared to 89.1% for ideal body weight, P = 0.97). After we adjusted for gender, age, body mass index, concomitant 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors, infection type, and organism type, clinical success rates remained similar between groups (adjusted odds ratio of 0.68 in favor of actual body weight, 95% confidence interval [CI] of 0.13 to 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 dosing provides similar outcomes to actual body weight dosing for all patients and types of infections and organisms.
authors.affiliation: University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Ng
authors.forename: Lucas T
authors.initials: LT
authors.lastname: Schulz
authors.forename: Warren E
authors.initials: WE
authors.lastname: Rose
authors.forename: Barry C
authors.initials: BC
authors.lastname: Fox
authors.forename: David R
authors.initials: DR
authors.lastname: Andes
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Buhr
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Fish
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy; D001835:Body Weight / Q000187:drug effects*; D017576:Daptomycin / Q000009:adverse effects / Q000627:therapeutic use*; D016983:Enterococcus / Q000472:pathogenicity; D005260:Female; D006801:Humans; D056865:Ideal Body Weight / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013211:Staphylococcus aureus / Q000187:drug effects; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D017576:Daptomycin