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Daptomycin Dosage

Medically reviewed on September 7, 2017.

Applies to the following strengths: 500 mg; 350 mg

Usual Adult Dose for Skin and Structure Infection

4 mg/kg IV every 24 hours for 7 to 14 days

Use: For the treatment of complicated skin and skin structure infections (cSSSI) due to susceptible isolates of Staphylococcus aureus (including methicillin-resistant isolates), Streptococcus pyogenes, S agalactiae, S dysgalactiae subspecies equisimilis, and Enterococcus faecalis (vancomycin-susceptible isolates only)

Usual Adult Dose for Bacteremia

6 mg/kg IV every 24 hours for 2 to 6 weeks

Comments:
-This drug should not be used for the treatment of left-sided infective endocarditis due to S aureus; in the clinical trial, outcomes were poor.
-This drug has not been studied in patients with prosthetic valve endocarditis.
-Limited safety data regarding use of this drug beyond 28 days

Uses: For the treatment of patients with S aureus bloodstream infections (bacteremia), including those with right-sided infective endocarditis, due to methicillin-susceptible and methicillin-resistant isolates

Usual Adult Dose for Endocarditis

6 mg/kg IV every 24 hours for 2 to 6 weeks

Comments:
-This drug should not be used for the treatment of left-sided infective endocarditis due to S aureus; in the clinical trial, outcomes were poor.
-This drug has not been studied in patients with prosthetic valve endocarditis.
-Limited safety data regarding use of this drug beyond 28 days

Uses: For the treatment of patients with S aureus bloodstream infections (bacteremia), including those with right-sided infective endocarditis, due to methicillin-susceptible and methicillin-resistant isolates

Usual Pediatric Dose for Skin and Structure Infection

1 to less than 2 years: 10 mg/kg IV every 24 hours
2 to 6 years: 9 mg/kg IV every 24 hours
7 to 11 years: 7 mg/kg IV every 24 hours
12 to 17 years: 5 mg/kg IV every 24 hours

Duration of therapy: Up to 14 days

Use: For the treatment of cSSSI due to susceptible isolates of S aureus (including methicillin-resistant isolates), S pyogenes, S agalactiae, S dysgalactiae subspecies equisimilis, and E faecalis (vancomycin-susceptible isolates only)

Usual Pediatric Dose for Bacteremia

1 to 6 years: 12 mg/kg IV every 24 hours
7 to 11 years: 9 mg/kg IV every 24 hours
12 to 17 years: 7 mg/kg IV every 24 hours

Duration of therapy: Up to 42 days

Use: For the treatment of S aureus bloodstream infections (bacteremia)

Renal Dose Adjustments

Adult patients:
CrCl less than 30 mL/min:
-For cSSSI: 4 mg/kg IV every 48 hours
-For S aureus bloodstream infections: 6 mg/kg IV every 48 hours

Pediatric patients: Not indicated.

Comments:
-Dose has not been established in pediatric patients with renal dysfunction.

Liver Dose Adjustments

Mild to moderate liver dysfunction: No adjustment recommended.
Severe liver dysfunction (Child-Pugh C): Data not available

Precautions

Safety and efficacy have not been established in patients younger than 1 year; this drug is not recommended for use in these patients.

Consult WARNINGS section for additional precautions.

Dialysis

Adult patients:
Hemodialysis and CAPD:
-For cSSSI: 4 mg/kg IV every 48 hours
-For S aureus bloodstream infections: 6 mg/kg IV every 48 hours

Pediatric patients: Data not available

Comments:
-This drug should be administered after hemodialysis on hemodialysis days.

Other Comments

Administration advice:
-Adult patients: Administer this drug IV either by injection over 2 minutes or by infusion over 30 minutes.
-Pediatric patients: Do not administer by injection over 2 minutes.
---For patients 1 to 6 years: Administer this drug via IV infusion over 60 minutes.
---For patients 7 to 17 years: Administer this drug via IV infusion over 30 minutes.
-Cubicin(R): Administer IV in 0.9% sodium chloride injection.
-If same IV line used for sequential infusion of other drugs, flush the line before and after infusion of this drug with a compatible IV solution.

Storage requirements:
-The 2 formulations have differences regarding storage; the manufacturer product information should be consulted and followed carefully.
-The in-use storage conditions of reconstituted and diluted solutions should not be exceeded.
Cubicin(R):
-Lyophilized powder: Store original packages under refrigeration, at 2C to 8C (36F to 46F); avoid excessive heat.
-Reconstituted solution: Stable in the vial for 12 hours at room temperature and up to 48 hours when refrigerated at 2C to 8C (36F to 46F)
-Diluted solution: Stable in the infusion bag for 12 hours at room temperature and 48 hours when refrigerated
-Combined storage time (reconstituted solution in vial and diluted solution in infusion bag) should not exceed 12 hours at room temperature or 48 hours when refrigerated.
Cubicin(R) RF:
-Lyophilized powder: Store original packages at 20C to 25C (68F to 77F); excursion permitted to 15C to 30C (59F to 86F).
-In-use shelf-life with Sterile Water for Injection as diluent: 1 day (vial, syringe) or 19 hours (IV bag) at room temperature (20C to 25C [68F to 77F]) and 3 days (vial, syringe, IV bag) when refrigerated (2C to 8C [36F to 46F])
-In-use shelf-life with Bacteriostatic Water for Injection as diluent: 2 days (vial, syringe, IV bag) at room temperature and 3 days (vial) or 5 days (syringe, IV bag) when refrigerated

Reconstitution/preparation techniques:
-The 2 formulations have differences regarding reconstitution; the manufacturer product information should be consulted and followed carefully.
-Cubicin(R): Should be reconstituted with 0.9% sodium chloride injection
-Cubicin(R) RF: Should be reconstituted with Sterile Water for Injection or Bacteriostatic Water for Injection; saline-based diluents should not be used for reconstitution in the vial (resulting hyperosmotic solution may cause infusion site reactions if administered as IV injection over 2 minutes)
-Both formulations (for IV infusion): The appropriate volume of the reconstituted solution (concentration of 50 mg/mL) should be further diluted into an IV infusion bag containing the specified volume of 0.9% sodium chloride injection; the manufacturer product information should be consulted.

IV compatibility:
-Compatible IV solutions: Cubicin(R): 0.9% sodium chloride injection, lactated Ringer's injection; reconstituted Cubicin(R) RF: Sterile Water for Injection, Bacteriostatic Water for Injection, 0.9% sodium chloride injection
-Incompatible: Dextrose-containing diluents, ReadyMED(R) elastomeric infusion pumps
-Limited data regarding compatibility with other IV products; additives and other drugs should not be added to this drug or infused concurrently through the same IV line.

General:
-Appropriate specimens for microbiological examination should be obtained before therapy to isolate and identify infecting organisms and to establish susceptibility to this drug.
-Culture and susceptibility information should be considered when selecting treatment or, if no data are available, local epidemiology and susceptibility patterns may be considered when selecting empiric therapy; empiric therapy may be started before test results are known.
-Combination therapy may be clinically indicated if documented or presumed pathogens include gram-negative or anaerobic organisms.
-This drug is not indicated for the treatment of pneumonia.
-This drug is not recommended for patients younger than 1 year due to risk of potential muscular, neuromuscular, and/or nervous system (peripheral and/or central) effects seen in neonatal dogs.

Monitoring:
-Infections/Infestations: Blood cultures (repeat if persisting or relapsing S aureus bacteremia/endocarditis or poor clinical response); MIC susceptibility (if blood culture positive for S aureus)
-Musculoskeletal: For muscle pain or weakness, especially of distal extremities; creatine phosphokinase (CPK) levels (weekly; more often if CPK elevations during therapy or recent prior/concurrent HMG-CoA reductase inhibitor therapy; more than once a week in adults with renal dysfunction)
-Nervous System: For neuropathy
-Renal: Renal function (more than once a week in adults with renal dysfunction)

Patient advice:
-Avoid missing doses and complete the entire course of therapy.
-Report muscle pain or weakness (especially in forearms and lower legs), tingling or numbness, and any symptoms of cough, breathlessness, or fever.
-Consult physician at once if watery and bloody stools (with or without stomach cramps and fever) develop.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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