Evaluation of a daptomycin dose-optimization protocol

• Published in: American journal of health-system pharmacy 2012-06, Vol.69 (11), p.979-984
• Main Authors: Tran, Truc T, Palmer, Hannah R, Weston, Jaye, Hirsch, Elizabeth B, Shah, Dhara N, Cottreau, Jessica, Tam, Vincent H, Garey, Kevin W
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - therapeutic use; Case studies; Creatine Kinase - blood; Cross infection; Daptomycin - administration & dosage; Daptomycin - adverse effects; Daptomycin - therapeutic use; Diagnosis; Dose-Response Relationship, Drug; Drug Monitoring - methods; Drug therapy; Female; Gram-Positive Bacterial Infections - drug therapy; Gram-Positive Bacterial Infections - microbiology; Hospitalization; Humans; Male; Medical protocols; Middle Aged; Nosocomial infections; Patient Care Team - organization & administration; Practice Guidelines as Topic; Practice Patterns, Physicians' - statistics & numerical data; Retrospective Studies; Vancomycin Resistance; Young Adult
• ISSN: 1079-2082; 1535-2900
• DOI: 10.2146/ajhp110279

The impact of an institutional protocol intended to improve daptomycin dosing for vancomycin-resistant enterococci (VRE) infections was investigated. Daptomycin has been reported to have optimal activity against VRE at weight-based doses of ≥8 mg/kg. As part of an initiative to optimize daptomycin dosing for all indications and regimens, a large medical center implemented a protocol restricting daptomycin prescribing to infectious-diseases specialists and a nomogram recommending elevated daptomycin dosing for all VRE infections, with baseline and weekly creatinine phosphokinase (CPK) determinations during daptomycin therapy. Protocol implementation was preceded by educational efforts targeting medical and pharmacy staff. A retrospective study was conducted to compare prescribing behavior and safety monitoring rates during the 12 months before and 16 months after protocol implementation; the baseline characteristics of the preimplementation cohort (n = 95) and postimplementation cohort (n = 72) were similar. The mean daptomycin doses before and after the protocol was implemented were 453 mg (6.1 mg/kg) and 576 mg (7.6 mg/kg), respectively. After protocol implementation, there were significant increases in the proportion of patients who received doses of ≥8 mg/kg (52% in the postimplementation period versus 4% in the preimplementation period, p < 0.05) and in the rate of baseline CPK assessment (64% versus 43%, p < 0.05). Implementation of a daptomycin dosing protocol by a multidisciplinary antimicrobial stewardship team optimized treatment by increasing the mean dose of daptomycin administered to hospitalized adults with non-urinary VRE infections and improved the rate of safety monitoring.