title: Daptomycin dosing strategies in patients receiving thrice-weekly intermittent hemodialysis.
abstract: OBJECTIVE
  To determine the optimal dosing regimen of daptomycin in patients receiving thrice-weekly hemodialysis.
  
  
  METHODS
  Literature was accessed via PubMed using the terms daptomycin and hemodialysis through July 2013. Reference citations from publications identified were reviewed.
  
  
  METHODS
  English language articles meeting the search criteria were evaluated. Studies were included if they addressed either thrice-weekly or intradialytic daptomycin administration.
  
  
  RESULTS
  Daptomycin is approved for the treatment of bloodstream infections due to methicillin-resistant Staphylococcus aureus and other Gram-positive organisms. Rapid bactericidal activity and limited potential for drug interactions make daptomycin an attractive agent. However, the daptomycin prescribing information recommends dosing every 48 hours in patients receiving hemodialysis, which results in dyssynchrony of dosing and dialysis sessions every other week. Studies evaluating a dosing regimen of daptomycin thrice weekly, coinciding with dialysis, indicate that pharmacokinetic and pharmacodynamic parameters are appropriate for therapeutic success. However, to maintain adequate serum drug concentrations throughout the 72-hour interdialytic period, an additional 50% of the dose should be provided to account for the longer interval. Intradialytic dosing, with the administration of daptomycin infusion beginning during the final 30 minutes of dialysis, may also require a dose increase. Limited clinical outcomes data have been reported, but no significant safety concerns have been identified.
  
  
  CONCLUSIONS
  Administration of daptomycin doses thrice weekly on hemodialysis days appears to be both safe and reasonable. Doses should be increased preceding the 72-hour interdialytic period or if daptomycin is infused during dialysis.
authors.affiliation: South Carolina College of Pharmacy/Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Molly
authors.initials: M
authors.lastname: Haselden
authors.forename: Molly
authors.initials: M
authors.lastname: Leach
authors.forename: Nicole
authors.initials: N
authors.lastname: Bohm
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D001424:Bacterial Infections / Q000188:drug therapy* / Q000378:metabolism; D017576:Daptomycin / Q000008:administration & dosage* / Q000493:pharmacokinetics; D004334:Drug Administration Schedule; D006801:Humans; D006435:Renal Dialysis
chemical_list: D000900:Anti-Bacterial Agents; D017576:Daptomycin
keywords: daptomycin; hemodialysis