Efficacy and Safety of Weight-based Dosing of Daptomycin in Obese Patients: A Systematic Review

Pharmacy Practice

  • Haytham A. Wali1Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia.
  • Nura Alshehab2Pharmacy Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.
  • Zainab Al-Omran3Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Department of Pharmacy Services, Almana General Hospital, Khobar, Saudi Arabia.
  • Sara Al-Maghem3Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Department of Pharmacy Services, Almana General Hospital, Khobar, Saudi Arabia.
  • Noura Al-Dughaim1Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia.
  • Jawaher Al-Shamrani1Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia.
  • Mohammed Y. Alshami4Pharmaceutical Care Services, King Abdulaziz Hospital, Ministry of National Guard Health Affairs, Al-Ahsa, Saudi Arabia.
  • Sawsan M. Kurdi5Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
  • Abdulaziz S. Almulhim1Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia.

Volume 21 Issue 4 Pages 1-9

DOI: 10.18549/PharmPract.2023.4.2882

Abstract

Purpose: To provide a comprehensive review of daptomycin weight-based dosing methods for obese patients. Methods: PubMed, Embase, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched through December 31, 2022. Studies relevant to daptomycin weight-based dosing methods in obese adult patients were included. Results: Sixteen studies were included, of which five were case reports and 11 were cohort studies. Obese patients were included in all case reports, of which one was pregnant. The infections improved after receiving a daptomycin dose based on actual body weight (ABW) in all cases. Seven studies demonstrated that ABW, ideal body weight (IBW), and adjusted body weight (AjBW)-based daptomycin dosing differed in terms of treatment success, microbiological clearance, and creatinine phosphokinase (CPK) elevation. However, AjBW was not statistically equivalent to ABW in all evaluated outcomes, except for treatment success. Three studies showed a higher area under the concentration-time curve (AUC) by 60% in obese patients, whereas two studies indicated a higher maximum plasma concentration (Cmax) of ~2 folds. One study demonstrated that obese patients had higher levels of total clearance and volume of distribution, whereas other pharmacokinetic parameters were comparable between obese and non-obese patients. Conclusion: While most of the available evidence reported daptomycin dosing based on actual or total body weight, a few other studies have reported the use of ideal or adjusted body weight. A significant elevation in CPK was observed when daptomycin was administered based on AdjBW, but not with ABW and IBW. Further research is required to determine the optimal daptomycin weight-based dosing method in obese patients.

Keywords

  • daptomycin
  • obesity
  • body weight
  • creatine phosphokinase
  • drug dosage calculation
Pharmacy Practice

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