Utility Assessment of a Pharmacy to Dose Daptomycin Protocol: A Retrospective Cohort Study

Background: Pharmacy-to-dose (PTD) services describe an established practice where providers consult pharmacists for various medication dosing. In 2019, several institutions approved a daptomycin protocol, which allowed pharmacists to select doses based on provider-selected indications, renal function, and body mass index (BMI). Objective: This study aims to determine the utility of a daptomycin PTD consult service. Methods: A retrospective analysis was conducted using data from 4 community hospitals between July 19, 2019 and October 31, 2021. The 2 comparative cohorts included patients who started on daptomycin with and without PTD services. The primary endpoint was the proportion of patients receiving appropriate initial dosing of daptomycin. Results: A total of 297 patients met the inclusion criteria, with 128 (43.1%) in the PTD group and 169 (56.9%) in the non-PTD group. The primary endpoint of appropriate initial dosing occurred significantly more in the PTD group (92.2% vs 82.8%, P = 0.02). Baseline creatine phosphokinase (CPK) was ordered significantly more in the PTD group (88.3% vs 77.5%, P = 0.02). A nonsignificant trend was seen in favor of the PTD arm (80% vs 58.3%, P = 0.22) for dose adjustments required within the first 24 hours. Conclusion and Relevance: The use of a PTD daptomycin protocol was associated with a significant increase in appropriate initial dosing and baseline CPK monitoring compared with traditional provider order entry.