Evaluation of a standardized daptomycin dosing nomogram.

Purpose: Implementation of a standardized daptomycin dosing protocol in a community teaching hospital to determine potential cost savings, effectiveness, and safety is presented.

Methods: A retrospective review of randomly selected patients receiving daptomycin therapy from October 2013 to January 2014 was performed to establish a preimplementation patient control group. A specific time for preparing daptomycin in the i.v. room was used based on a standardized administration time of 4 p.m. Reconstituted doses were stored for up to 48 hours in the refrigerator in plastic syringes. All daptomycin doses were given by rapid i.v. administration. For all patients who received daptomycin, the protocol specified that a baseline creatine phosphokinase level be evaluated within 24 hours of the start date and on day 3, day 7, and weekly thereafter until daptomycin therapy was completed or discontinued.

Results: The most frequent indications for daptomycin use preimplementation and postimplementation were related to catheter use or persistent bacteremia and skin and soft tissue infections. Through the implementation of the standardized dosing nomogram and optimization of i.v. room workflow, the amount of waste decreased by 21,500 mg and generated a savings of $13,845 over the course of the four-month study period, which can be extrapolated to $41,535 annually. The infection cure rate at completion of therapy was 56.7% in the preimplementation population compared with 70.0% in the postimplementation population. Daptomycin was well tolerated at the standardized doses used in the study.

Conclusion: Implementation of a standardized dosing nomogram reduced the amount of daptomycin wasted and resulted in cost savings. The standardized dosing nomogram did not impair the rate of clinical effectiveness or cause adverse events.