Maximum Recommended Dose of Daptomycin Per Day
For adults with normal renal function, the maximum recommended dose of daptomycin is 12 mg/kg per day, administered as a single daily intravenous infusion. 1
Dosing by Clinical Indication
The maximum dose varies based on the specific infection being treated:
Standard Indications
- Complicated skin and soft tissue infections (cSSTI): 4 mg/kg once daily 2, 1
- Staphylococcus aureus bacteremia: 6 mg/kg once daily (standard dose) 2, 1
- Infective endocarditis: 6-10 mg/kg once daily 2
Multidrug-Resistant Enterococcal Infections
- Maximum dose: 10-12 mg/kg once daily for vancomycin-resistant enterococcal endocarditis 2
- This higher dosing is particularly important for strains with elevated MICs to daptomycin (≥3 μg/mL) within the susceptible range 2
Critical Dosing Considerations
The 12 mg/kg daily dose represents the highest dose studied in controlled clinical trials and serves as the upper safety limit. 1 This maximum was established in patients with creatinine clearance >80 mL/min 3
Renal Impairment Adjustments
For patients with creatinine clearance <30 mL/min:
- Dosing interval changes to every 48 hours (not daily) 1, 3
- The dose per administration remains the same (e.g., 6 mg/kg), but frequency decreases 1
- For bacteremia with severe renal impairment: 6 mg/kg every 48 hours provides appropriate exposure 3
- Patients on hemodialysis or CAPD: administer dose after dialysis session 1
Pediatric Populations (Ages 1-17 Years)
The dosing differs from adults and is weight-based but follows different schedules:
- Ages 7-17 years: 5 mg/kg once daily for cSSTI; 7 mg/kg once daily for bacteremia 1
- Ages 1-6 years: 10 mg/kg once daily for cSSTI; 12 mg/kg once daily for bacteremia 1
Safety Monitoring at Higher Doses
When using doses ≥6 mg/kg, particularly in renally impaired patients, CPK monitoring should occur more frequently than once weekly. 4, 5 The median time to CPK elevation in renally impaired patients was 11.5 days, suggesting early and frequent monitoring is essential 4
Key Safety Thresholds
- Discontinuation due to elevated CPK occurred in 3.8% of renally impaired patients 4
- Steady-state trough levels (Cmin) above 24.3 mg/L may increase toxicity risk 5
- Both renal function and CPK require more frequent monitoring in patients with baseline renal impairment 1
Common Pitfalls to Avoid
Do not use daily dosing in patients with CrCl <30 mL/min—this leads to drug accumulation and increased toxicity risk 1, 3. The every-48-hour interval is critical for safety in this population.
Avoid underdosing in bacteremia—using 4 mg/kg every 48 hours in renally impaired patients with bacteremia results in substantially more patients being underexposed compared to 6 mg/kg every 48 hours 3. For serious infections like bacteremia or endocarditis, the 6 mg/kg dose (or higher for resistant organisms) is necessary even with renal impairment, but the interval must be extended 2, 3.