Observational studyEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology2025
Safety of high-dose daptomycin in obese patients: a multicentric retrospective study.
Observational study in European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeObese patients treated with daptomycin at 4 mg/kg have a 30% increased drug exposure, potentially raising the risk of adverse events (AEs) like rhabdomyolysis. Given limited data on the safety of higher doses (10 mg/kg) in this population, this study aimed to assess the safety of high-dose daptomycin in obese patients and to identify potential AEs risk factors.
methodsThis multicenter, retrospective observational study was conducted from June 2021 to May 2022 using medical records. Patients with a BMI > 30 kg/m
resultsA total of 1 303 patients were included: 970 non-obese and 333 Ob patients. These patients received an average daptomycin dose of 9.9 mg/kg based on actual body weight for an average treatment duration of 8.27 days. One-third of the patients had CK monitoring. AEs rates were 3.5% for the n-Ob group vs. 8.7% in the Ob group (p < 0.01). Ob patients had significantly higher CK levels (n-Ob, 9.5%; Ob, 20.3%; p = 0.001), and severe elevation (n-Ob, 5.2%; Ob, 10.9%; p = 0.03). Factors increasing AE risk included obesity, concomitant prescriptions of drugs with risk of rhabdomyolysis, eGFR 30-60 mL/min, and daptomycin duration (OR = 2.42; 4.34; 2.03 and 1.05, respectively, p < 0.001). On the opposite, consultation with an infectious disease specialist reduced risk (OR = 0.52, p = 0.024).
conclusionThis study highlights that obese patient has a significantly increased risk of AEs with high dose of daptomycin compared to non-obese patients. Adjusted body weight dosing may be considered to reduce AEs risk.
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