Daptomycin
General
- Type: bacterial antibiotic
- Dosage Forms: IV
- Common Trade Names: Cubicin
- Good soft tissue and MSK penetration, but poor lung penetration as it is inactivated by pulmonary surfactant[1][2]
- Daptomycin is typically added to treat community enterococcus or vancomycin-resistant enterococcus, but VRE pneumonia requires linezolid
- Add MRSA antibiotic with adequate lung penetration such as linezolid at standard dosing or vancomycin dosing aimed at higher serum concentrations[3]
Adult Dosing
- Complicated bacterial skin infections:
- 4mg/kg q24h x7-14 days
- Staph bacteremia:
- 6mg/kg IV q24h x2-6 wks
- Renal dosing
- CrCl <30, give q48h
- HD: give dose after dialysis, no supplement
- PD: no supplement
Pediatric Dosing
- Unavailable
Special Populations
- Pregnancy Rating: B
- Lactation: Infant risk cannot be ruled out
- Renal Dosing
- Adult
- Pediatric
- Hepatic Dosing
- Adult
- Pediatric
Contraindications
- Allergy to class/drug
- CK > 10x upper limit normal
- CK > 10x upper limit normal with myopathy
- caution in elderly
- caution in recent antibiotic-associated colitis
Adverse Reactions
Serious
- C. difficile diarrhea
- Superinfection
- Eosinophilic pneumonia
- Anaphylaxis
- Drug rash
- Thrombocytopenia
- Myopathy
- Rhabdomyolysis
- Peripheral neuropathy
Common
- Insomnia
- Pharyngeal pain
- Elevated CK
- Chest pain
- Edema
- Abdominal pain
- Pruritis
- Headache
- Diarrhea
Pharmacology
- Half-life: 8-9 h
- Metabolism: unknown
- Excretion: Urine 78%
- Mechanism of Action: Bactericidal, binds/depolarizes bacterial membranes
Antibiotic Sensitivities[4]
Key
- S susceptible/sensitive (usually)
- I intermediate (variably susceptible/resistant)
- R resistant (or not effective clinically)
- S+ synergistic with cell wall antibiotics
- U sensitive for UTI only (non systemic infection)
- X1 no data
- X2 active in vitro, but not used clinically
- X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
- X4 active in vitro, but not clinically effective for strep pneumonia
See Also
References
- Estes KS and Derendorf K. Comparison of the pharmacokinetic properties of vancomycin, linezolid, tigecyclin, and daptomycin. Eur J Med Res. 2010; 15(12): 533–543.
- Silverman JA et al. Inhibition of Daptomycin by Pulmonary Surfactant: In Vitro Modeling and Clinical Impact. J Infect Dis. (2005) 191 (12): 2149-2152.
- Stein GE and Wells EM. The importance of tissue penetration in achieving successful antimicrobial treatment of nosocomial pneumonia and complicated skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus: vancomycin and linezolid. Curr Med Res Opin. 2010 Mar;26(3):571-88.
- Sanford Guide to Antimicrobial Therapy 2014
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