What is the dosage for Daptomycin (Dapt) for treating infections?

Daptomycin Dosage for Treating Infections

For treating infections, daptomycin (Dapt) should be dosed at 4 mg/kg IV once daily for complicated skin and skin structure infections (cSSSI) and 6 mg/kg IV once daily for Staphylococcus aureus bacteremia, with higher doses of 8-10 mg/kg recommended for complicated bacteremia and endocarditis. 1, 2

Adult Dosing Recommendations

Complicated Skin and Skin Structure Infections (cSSSI)

• Administer 4 mg/kg IV once daily for 7-14 days 2
• Can be administered by injection over a 2-minute period or by infusion over a 30-minute period 2

Staphylococcus aureus Bacteremia

• For uncomplicated bacteremia: 6 mg/kg IV once daily for at least 2 weeks 1, 2
• For complicated bacteremia: 6 mg/kg IV once daily for 4-6 weeks, with some experts recommending higher doses of 8-10 mg/kg IV once daily 1, 3
• For infective endocarditis: 6 mg/kg IV once daily for 6 weeks, with some experts recommending higher doses of 8-10 mg/kg IV once daily 1

Dosage Adjustment for Renal Impairment

• For patients with creatinine clearance <30 mL/min, including those on hemodialysis or continuous ambulatory peritoneal dialysis (CAPD) 2:
  • cSSSI: 4 mg/kg IV once every 48 hours
  • S. aureus bacteremia: 6 mg/kg IV once every 48 hours
• When possible, administer following completion of hemodialysis on hemodialysis days 2

Pediatric Dosing Recommendations

Complicated Skin and Skin Structure Infections (cSSSI)

• 12-17 years: 5 mg/kg IV once daily infused over 30 minutes for up to 14 days 2
• 7-11 years: 7 mg/kg IV once daily infused over 30 minutes for up to 14 days 2
• 2-6 years: 9 mg/kg IV once daily infused over 60 minutes for up to 14 days 2
• 1 to <2 years: 10 mg/kg IV once daily infused over 60 minutes for up to 14 days 2

Staphylococcus aureus Bacteremia

• 12-17 years: 7 mg/kg IV once daily infused over 30 minutes for up to 42 days 2
• 7-11 years: 9 mg/kg IV once daily infused over 30 minutes for up to 42 days 2
• 1-6 years: 12 mg/kg IV once daily infused over 60 minutes for up to 42 days 2

Important Clinical Considerations

Advantages of Daptomycin

• Rapid, concentration-dependent bactericidal activity against Gram-positive pathogens, including MRSA 4, 5
• Once-daily dosing simplifies administration 5, 6
• No cross-resistance with other antibiotic classes 4

Limitations and Precautions

• Not indicated for the treatment of pneumonia due to inactivation by pulmonary surfactant 3, 2
• Not indicated for left-sided infective endocarditis due to S. aureus 2
• Not recommended in pediatric patients younger than one year of age due to potential effects on muscular, neuromuscular, and/or nervous systems 2
• Monitor CPK levels to detect potential myopathy and rhabdomyolysis 2

Higher Dose Considerations

• Higher doses (8-12 mg/kg) may be considered for persistent MRSA bacteremia or complicated infections 3, 7
• The rationale for higher doses includes enhanced clinical success rates, treatment of pathogens with reduced susceptibility, and minimizing resistance development 7

Combination Therapy

• For persistent MRSA bacteremia, combination therapy with high-dose daptomycin (10 mg/kg/day) and another agent may be considered 3
• Addition of gentamicin or rifampin to daptomycin is not recommended for bacteremia or native valve infective endocarditis 1

Preparation and Administration

• Reconstitute with 0.9% sodium chloride to achieve a concentration of 50 mg/mL 2
• Avoid vigorous agitation or shaking of the vial during reconstitution to minimize foaming 2
• For adults, administer by IV injection over 2 minutes or by infusion over 30 minutes 2
• For pediatric patients, only administer by infusion over 30-60 minutes based on age 2