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

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Haytham A. Wali https://orcid.org/0000-0001-6279-3809
Nura Alshehab
Zainab Al-Omran
Sara Al-Maghem
Noura Al-Dughaim
Jawaher Al-Shamrani
Mohammed Y. Alshami
Sawsan M. Kurdi
Abdulaziz S. Almulhim


Antibiotic, Obesity, Drug safety, Adverse drug effects


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.

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