Daptomycin usage

[ryanella]

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anyone have thoughts on usage trends for dapto? Given the high price, is use becoming more restrictive? I would think with vanc MIC's going higher and doses going higher, it is getting more costly and toxic?

 

[Its Z]

anyone have thoughts on usage trends for dapto?

If used appropriately due to vanco treatment faiure, I'm all for it.

Given the high price, is use becoming more restrictive?

It's not becoming more restrictive per se as it's difficult to restrict drugs once it's been used widely. So this needs to be done upfront as drug is added to the formulary. Strict use criteria is how it should be done.

I would think with vanc MIC's going higher and doses going higher, it is getting more costly and toxic?

mmmm.. what's getting more costly and toxic? Vanco? Vanco is a very inexpensive treatment option including the monitoring compared to Linezolid and Daptomycin. As far as toxicity, renal toxicity is typically reversed once the treatment ends.

 

[nafcillin]

is it dapto that can't be used for PNA because it doesn't penetrate the lungs? or is that linezolid?

 

[ttopping]

is it dapto that can't be used for PNA because it doesn't penetrate the lungs? or is that linezolid?

Yea it's dapto, it gets deactivated by lung surfactant

 

[KARM12]

Dapto is a good drug when used appropriately. Hopsitals should establish appropriate use criteria. There are still questions that arise with dapto use that are being studied...high dose, resistance questions.

If used appropriately due to vanco treatment faiure, I'm all for it.



It's not becoming more restrictive per se as it's difficult to restrict drugs once it's been used widely. So this needs to be done upfront as drug is added to the formulary. Strict use criteria is how it should be done.



mmmm.. what's getting more costly and toxic? Vanco? Vanco is a very inexpensive treatment option including the monitoring compared to Linezolid and Daptomycin. As far as toxicity, renal toxicity is typically reversed once the treatment ends.

 

[StewardshipDude]

We have restrictive criteria on dapto and linezolid. Our problem is not what we control in house, but our very ID comrades who transition patients to their office infusion suites for dapto. It is so clear to see. Based upon the payor mix for patients, certain folks get sent to the ID owned clinic for dapto while we get stuck with the vanc patients to smolder 2 weeks.