Clinical outcomes of daptomycin in patients with augmented renal clearance: a case series

Augmented renal clearance (ARC) can result in rapid elimination of antibiotics cleared by the kidneys, potentially causing suboptimal drug levels. There is limited information available on the appropriate dosing of daptomycin for individuals with ARC. This study aimed to assess the effectiveness of daptomycin treatment in patients with ARC, focusing on both clinical and microbiological outcomes.

We conducted a single-center retrospective case series involving patients with bacteremia or sepsis and ARC (defined as creatinine clearance ≥130 mL/min) who were treated with daptomycin from January 2019 to July 2025. Clinical effectiveness, microbiological outcomes, and adverse events were evaluated without formal comparative statistical analysis.

Among 488 screened patients, 11 met the inclusion criteria. Eight patients received ≤6 mg/kg/day, while three received >6 mg/kg/day. Excluding one non-evaluable patient, clinical success was observed in 3/3 patients receiving >6 mg/kg/day and in 5/7 patients receiving ≤6 mg/kg/day. Microbiological eradication was observed in 2/3 and 4/8 patients, respectively. Among patients with methicillin-resistant Staphylococcus aureus infection, microbiological failure occurred more frequently in the ≤6 mg/kg/day group. No apparent dose-related increases in adverse events were observed. Baseline characteristics and treatment details varied across cases.

Although standard dose daptomycin remained the most common prescribing pattern, outcomes among these cases were mixed, highlighting the difficulty of interpreting treatment response on the basis of dose alone in patients with ARC. Prospective studies incorporating PK/PD assessment are needed to clarify optimal dosing strategies in this population.