What is the recommended dosage of daptomycin (Cubicin) for a 196-pound male with presumed normal renal function?

Daptomycin Dosage for a 196-Pound Male

For a 196-pound (89 kg) male with normal renal function, administer daptomycin 4 mg/kg IV once daily (356 mg) for complicated skin and soft tissue infections, or 6 mg/kg IV once daily (534 mg) for bacteremia or endocarditis. 1, 2

Weight-Based Dosing Calculation

• Patient weight: 196 pounds = 89 kg
• For complicated skin/soft tissue infections: 4 mg/kg × 89 kg = 356 mg IV once daily 1, 2
• For bacteremia (uncomplicated): 6 mg/kg × 89 kg = 534 mg IV once daily 1
• For complicated bacteremia or endocarditis: 6-10 mg/kg × 89 kg = 534-890 mg IV once daily 1

Indication-Specific Dosing

Skin and Soft Tissue Infections

• Standard dose: 4 mg/kg IV once daily for complicated infections 1, 2
• Duration: 7-14 days 1

Bacteremia and Endocarditis

• Uncomplicated bacteremia: 6 mg/kg IV once daily for at least 2 weeks 1
  • Uncomplicated defined as: no endocarditis, no prosthetic devices, negative blood cultures within 2-4 days, defervescence within 72 hours, no metastatic infection 1
• Complicated bacteremia: 6 mg/kg IV once daily for 4-6 weeks 1
• Native valve endocarditis: 6 mg/kg IV once daily for 6 weeks 1
• Higher doses (8-10 mg/kg): Consider for complicated MRSA bacteremia, endocarditis, or organisms with reduced susceptibility 1

Renal Function Considerations

This patient has presumed normal renal function, so standard once-daily dosing applies. 2

• Normal renal function (CrCl >80 mL/min): Administer full dose once every 24 hours 2
• Mild impairment (CrCl 50-80 mL/min): No adjustment needed, continue once every 24 hours 2
• Moderate impairment (CrCl 30-50 mL/min): No adjustment needed, continue once every 24 hours 2
• Severe impairment (CrCl <30 mL/min): Administer once every 48 hours 2
• Hemodialysis: Administer once every 48 hours, after dialysis 2

High-Dose Considerations

For severe or refractory infections, doses of 8-10 mg/kg (712-890 mg for this patient) may be considered. 1

• Higher doses achieve improved pharmacodynamic targets (AUC/MIC >250) for organisms with reduced susceptibility 1
• Doses up to 12 mg/kg have been studied and found safe in healthy volunteers 3
• High-dose daptomycin (8-12 mg/kg) is recommended for VRE bloodstream infections 1
• Some experts recommend 8-10 mg/kg for complicated MRSA bacteremia and endocarditis 1

Critical Safety Monitoring

Monitor creatine phosphokinase (CPK) levels at baseline and at least weekly during therapy. 1, 4

• Discontinue if CPK elevation occurs with muscle symptoms or if CPK >5 times upper limit of normal 2
• In renally impaired patients, consider monitoring CPK more frequently than weekly, as median time to CPK elevation is 11.5 days 4
• Avoid concurrent use of HMG-CoA reductase inhibitors when possible 2
• Monitor renal function, particularly if using higher doses 1

Common Pitfalls to Avoid

• Do not use for pneumonia: Daptomycin is inactivated by pulmonary surfactant and is contraindicated for pneumonia 2
• Do not underdose based on ideal body weight: Use actual body weight for dosing calculations 2
• Do not combine with aminoglycosides routinely: Addition of gentamicin to daptomycin for bacteremia or endocarditis is not recommended 1
• Do not use every-other-day dosing in normal renal function: This patient requires once-daily dosing 2
• Obtain follow-up blood cultures: Document clearance of bacteremia 2-4 days after initial positive cultures 1