Real-world daptomycin use with a focus on muscle toxicity: A multicentric retrospective study

Area of Science:

• Pharmacology
• Clinical Medicine
• Infectious Diseases

Background:

• Daptomycin is a key antibiotic for Gram-positive infections.
• Muscle toxicity is a known adverse effect of daptomycin therapy.
• Real-world adherence to daptomycin safety monitoring guidelines is not well-documented.

Purpose of the Study:

• To assess daptomycin prescribing patterns in French university hospitals.
• To identify factors associated with daptomycin-induced muscle toxicity.
• To evaluate the consistency of safety monitoring practices.

Main Methods:

• Retrospective multicenter study of 1,407 adult patients treated with daptomycin.
• Data collected on demographics, treatment, monitoring, and adverse events.
• Muscle toxicity defined by creatine kinase (CK) elevation or rhabdomyolysis; logistic regression used for risk factor analysis.

Main Results:

• High-dose daptomycin (≥8 mg/kg/day) was used in 93.9% of patients.
• CK monitoring occurred in only 34.2% of patients.
• Muscle toxicity reported in 4.9%, including rhabdomyolysis in 2.7%.
• Concomitant use of statins/fibrates (OR 6.68) and obesity (OR 2.25) were significant risk factors for muscle toxicity.

Conclusions:

• Daptomycin safety monitoring, particularly CK testing, was inconsistent despite high-dose usage.
• Systematic CK monitoring and careful evaluation of myotoxic co-medications are crucial.
• Mitigating daptomycin-related muscle toxicity requires vigilant clinical practice.