The impact of daptomycin therapeutic drug monitoring on clinical outcomes: a systematic review

Kelly A Cairns; Iain J Abbott; Michael J Dooley; Anton Y Peleg; Trisha N Peel; Andrew A Udy

doi:10.1016/j.ijantimicag.2023.106712

The impact of daptomycin therapeutic drug monitoring on clinical outcomes: a systematic review

Int J Antimicrob Agents. 2023 Feb;61(2):106712. doi: 10.1016/j.ijantimicag.2023.106712. Epub 2023 Jan 11.

Authors

Kelly A Cairns¹, Iain J Abbott², Michael J Dooley³, Anton Y Peleg⁴, Trisha N Peel⁵, Andrew A Udy⁶

Affiliations

¹ Department of Infectious Diseases, The Alfred and Central Clinical School, Monash University, Melbourne, VIC, Australia; Pharmacy Department, Alfred Health, Melbourne, VIC, Australia.
² Department of Infectious Diseases, The Alfred and Central Clinical School, Monash University, Melbourne, VIC, Australia; Microbiology Unit, Alfred Health, Melbourne, VIC, Australia.
³ Pharmacy Department, Alfred Health, Melbourne, VIC, Australia; Centre for Medicines Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia.
⁴ Department of Infectious Diseases, The Alfred and Central Clinical School, Monash University, Melbourne, VIC, Australia; Infection and Immunity Program, Monash Biomedicine Discovery Institute, Department of Microbiology, Monash University, Clayton, VIC, Australia.
⁵ Department of Infectious Diseases, The Alfred and Central Clinical School, Monash University, Melbourne, VIC, Australia.
⁶ Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia. Electronic address: andrew.udy@monash.edu.

PMID: 36640849
DOI: 10.1016/j.ijantimicag.2023.106712

Abstract

Aim: Daptomycin therapeutic drug monitoring (TDM) is a potentially valuable intervention for a relatively new drug. The aim of this study was to determine whether daptomycin TDM, including dose adjustment where necessary, improves the clinical outcomes of adult patients with Gram-positive infections.

Methods: A systematic review of English-language studies in MEDLINE (Ovid MEDLINE and Epub Ahead of Print, In-process, In-Data-Review & Other Non-Indexed Citations, Daily and Versions), EMBASE via OVID, Cochrane Central Register of Controlled Trials via the OVID platform, Scopus and Web of Science online databases was performed and conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. There was no discrimination on study type or time of publication.

Study selection: Adults (age ≥18 years) with a Gram-positive infection requiring treatment with daptomycin who received TDM, with subsequent reporting of serum concentrations and dose adjustment where necessary, were included.

Results: In total, 2869 studies were identified, of which nine met the inclusion criteria. No studies of daptomycin TDM including a relevant control arm have been published to date. All of the included studies were single-arm observational cohort studies. Broad heterogeneity was observed between the studies in terms of included pathogens, infection types, daptomycin TDM practices, reported clinical outcomes, and reporting of potential confounders.

Conclusions: No studies exploring the efficacy of routine daptomycin TDM on patient-centred outcomes in comparison with fixed dosing regimens have been published to date. This represents a key knowledge gap as opposed to an inherent lack of efficacy. Further well-designed, comparative studies are required to determine the role of daptomycin TDM in patients with Gram-positive infections.

Keywords: Daptomycin; Dose optimization; Therapeutic drug monitoring.

Publication types

Systematic Review

MeSH terms

Adolescent
Adult
Daptomycin* / therapeutic use
Drug Monitoring
Humans

Substances

Daptomycin