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Lower daptomycin dose for obese patients noninferior, cost-effective
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DENVER — A lower-dose daptomycin regimen adjusted for obese patients led to clinical outcomes comparable to a full-dosing strategy and was more cost-effective, according to the results of a pilot study presented here at the 2013 Interscience Conference on Antimicrobial Agents and Chemotherapy.
"Prescribing adjusted dose daptomycin in morbidly obese patients can help reduce costs and maintain similar clinical outcomes," study researcher Jerod Nagel, PharmD, told Infectious Disease News. "I would feel very comfortable giving adjusted dose daptomycin for patients with uncomplicated VRE bacteremia, but larger trials are needed to define the appropriate dose for complicated bacteremia, regardless of whether the patient is obese."
Jerod Nagel
Previous studies have shown that a daptomycin regimen based on actual body weight has led to higher serum levels in obese patients compared with normal-weight patients, and one study has demonstrated that obese patients are at a higher risk for developing daptomycin toxicity.
Nagel, a clinical specialist in infectious diseases at the University of Michigan Hospitals and Health System, and colleagues evaluated the clinical outcomes of 47 obese patients (BMI >30 kg/m2) with vancomycin-resistant enterococci who received 6 mg/kg daptomycin based on actual body weight or 6 mg/kg based on adjusted body weight.
A number of clinical outcomes, including mortality, length of hospitalization, mean time to microbiologic clearance, recurrent bacteremia and toxicity, were similar between the two patient groups. Additionally, receiving daptomycin based on adjusted body weight resulted in a mean daptomycin cost savings of $1,239 per patient.
"This pilot study suggests utilizing daptomycin based on adjusted body weight may result in similar clinical outcomes, while decreasing daptomycin cost," the researchers reported. "These results support further evaluation in large-scale trials."
Jerod Nagel, PharmD, can be reached at nageljl@umich.edu.
For more information:
Nagel J. #K-169. Presented at: ICAAC 2013; Sept. 10-13; Denver.
Disclosure: Nagel no relevant financial disclosures.