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Thamer A Almangour,1 Latifa S Almosabhi,2 Rahaf Almojel,1 Rawabi Althubaity,1 Sara Almuhisen,3 Abdullah Almohaizeie,4,5 Shuroug A Alowais,6– 8 Khalid Bin Saleh,6– 8 Nader Damfu,7,9,10 Sultan N Alotaibi,7,10,11 Namareq F Aldardeer,12 Haifa Alotaibi,4 Albandari A Alghamdi,4 Marwah Almuzaini,13 Abdulrahman Alyousef,6 Faisal Alnehari,14 Sara A Youssef,15 Moataz H Alharbi,12 Mohammed Al Musawa,16 Yazed Saleh Alsowaida17 1Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia; 2Clinical Pharmacy Services, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia; 3Pharmacy services Administration, King Fahad Medical City, Riyadh, Saudi Arabia; 4Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia; 5College of Pharmacy, Alfaisal University, Riyadh, Saudi Arabia; 6Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 7King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; 8Pharmaceutical Care Department, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia; 9Infection Prevention and Control Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia; 10King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; 11Department of Pharmaceutical Care Services, King Salman Specialized Hospital, Ministry of the National Guard-Health Affairs, Taif, Saudi Arabia; 12Medical and Clinical Affairs Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia; 13Pharmaceutical Care Services, King Salman Medical City, Ministry of Health, Medina, Saudi Arabia; 14Pharmaceutical Science Department, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 15Department of Pharmaceutical Care, Saudi German Hospital, Hail, 55481, Saudi Arabia; 16Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA; 17Department of Clinical Pharmacy, College of Pharmacy, University of Ha’il, Hail, 81442, Saudi ArabiaCorrespondence: Thamer A Almangour, Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh, 11451, Saudi Arabia, Email talmangour@ksu.edu.saPurpose: Daptomycin-approved dosing is based on actual body weight (ABW). However, the pharmacokinetics and pharmacodynamics of daptomycin are altered in obese patients, leading to increased daptomycin exposure owing to incomplete distribution into excess body tissues. Data regarding the use of alternative weight descriptors for daptomycin dosing are limited. This study aimed to investigate the effectiveness and safety of daptomycin in obese patients by using adjusted body weight (AdjBW).Methods: This retrospective multicenter cohort study in Saudi Arabia compared the outcomes of obese patients who received daptomycin based on AdjBW with those of obese and non-obese patients who received daptomycin based on ABW. The main outcomes included clinical cure, overall in-hospital mortality, and 30-day mortality. The safety outcomes were evaluated. Multivariate logistic regression was used to control for confounding variables.Results: A total of 293 patients met the inclusion: 43 patients in AdjBW group, 54 in the ABW group, and 196 in the non-obese group. When comparing the AdjBW and ABW obese groups, no statistically significant difference was observed in clinical cure (83.7% vs 77.8%; p = 0.461; OR, 0.1.47; 95% CI, 0.52– 4.12), overall in-hospital mortality (23.3% vs 35.2%; p = 0.200; OR, 0.56; 95% CI, 0.23– 1.37), or 30-day mortality (16.3% vs 27.8%; p = 0.174; OR, 0.51; 95% CI, 0.19– 1.38). Creatine phosphokinase elevation (8.6% vs 6%; p = 0.651) was similar between the two groups. Similar outcomes were observed when comparing the AdjBW and non-obese groups.Conclusion: Treatment with daptomycin based on AdjBW in obese patients had similar effectiveness and safety outcomes as treatment with daptomycin based on ABW in obese and non-obese patients. Therefore, future prospective studies are warranted.Keywords: daptomycin, obese, adjusted body weight, dosing