What is the recommended dose of IV daptomycin for a 208-pound patient with osteomyelitis?

Daptomycin Dosing for Osteomyelitis in a 208-Pound Patient

For a 208-pound (94.5 kg) patient with osteomyelitis, administer daptomycin 8 mg/kg IV once daily, which equals 756 mg (round to 750 mg) IV once daily. 1

Dosing Rationale

Higher doses of daptomycin (8-10 mg/kg) are specifically recommended for osteomyelitis rather than the standard 6 mg/kg dose used for uncomplicated bacteremia. 1 The IDSA guidelines explicitly note that "some experts recommend higher dosages of daptomycin at 8-10 mg/kg/dose IV once daily" for serious infections including osteomyelitis. 2, 1

Weight-Based Calculation

• Patient weight: 208 pounds = 94.5 kg
• Recommended dose: 8 mg/kg
• Total daily dose: 94.5 kg × 8 mg/kg = 756 mg IV once daily 1
• Practical rounding: 750 mg IV once daily is acceptable

Supporting Evidence for Higher Dosing

Clinical outcomes data support this higher dosing strategy:

• Retrospective registry data demonstrated that daptomycin doses >4 mg/kg achieved significantly higher clinical success rates (88%) compared to doses ≤4 mg/kg (65%, P=0.013). 3
• Treatment duration of ≥6 weeks was associated with better outcomes independent of dose, with success rates of 41.5% for ≥6 weeks versus 25.3% for <6 weeks (adjusted OR 0.55). 4

Administration Details

Administer as IV infusion over 30 minutes in adults (do NOT use the 2-minute IV push option for serious infections like osteomyelitis). 5

• Reconstitute 500 mg vial with 10 mL of 0.9% sodium chloride to achieve 50 mg/mL concentration 5
• Further dilute appropriate volume in 50 mL 0.9% sodium chloride infusion bag 5
• Infuse at 1.67 mL/minute over 30 minutes 5

Critical Adjunctive Therapy

Surgical debridement and drainage of associated soft-tissue abscesses is the mainstay of therapy and must be performed whenever feasible. 2, 1 Failure to perform adequate surgical debridement was associated with significantly higher treatment failure rates (24% vs 5%, P=0.045). 3

Treatment Duration

Treat for a minimum of 6-8 weeks. 1, 4 Some experts recommend additional 1-3 months of therapy for chronic infection or inadequate debridement. 1

Renal Dosing Adjustments

For patients with CrCl <30 mL/min (including hemodialysis): Reduce to 6 mg/kg every 48 hours, administered after hemodialysis on dialysis days. 5

Alternative Agents

If daptomycin cannot be used:

• Vancomycin 15-20 mg/kg IV every 8-12 hours (target trough 15-20 mcg/mL for osteomyelitis) 2, 1
• Linezolid 600 mg PO/IV twice daily for adults 1, 6