Daptomycin

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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]

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]

Group Organism Sensitivity
Gram Positive Strep. Group A, B, C, G S
Strep. Pneumoniae X23
Viridans strep X1
Strep. anginosus gp X1
Enterococcus faecalis S
Enterococcus faecium S
MSSA S
MRSA S
CA-MRSA S
Staph. Epidermidis S
C. jeikeium S
L. monocytogenes I
Gram Negatives N. gonorrhoeae R
N. meningitidis R
Moraxella catarrhalis R
H. influenzae R
E. coli R
Klebsiella sp R
E. coli/Klebsiella ESBL+ R
E coli/Klebsiella KPC+ R
Enterobacter sp, AmpC neg R
Enterobacter sp, AmpC pos R
Serratia sp X1
Serratia marcescens R
Salmonella sp R
Shigella sp X1
Proteus mirabilis X1
Proteus vulgaris R
Providencia sp. X1
Morganella sp. X1
Citrobacter freundii X1
Citrobacter diversus X1
Citrobacter sp. X1
Aeromonas sp X1
Acinetobacter sp. R
Pseudomonas aeruginosa R
Burkholderia cepacia R
Stenotrophomonas maltophilia R
Yersinia enterocolitica R
Francisella tularensis R
Brucella sp. R
Legionella sp. R
Pasteurella multocida X1
Haemophilus ducreyi R
Vibrio vulnificus R
Misc Chlamydophila sp X1
Mycoplasm pneumoniae X1
Rickettsia sp X1
Mycobacterium avium X1
Anaerobes Actinomyces X1
Bacteroides fragilis X1
Prevotella melaninogenica X1
Clostridium difficile X1
Clostridium (not difficile) X1
Fusobacterium necrophorum X1
Peptostreptococcus sp. X1

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

  1. 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.
  2. Silverman JA et al. Inhibition of Daptomycin by Pulmonary Surfactant: In Vitro Modeling and Clinical Impact. J Infect Dis. (2005) 191 (12): 2149-2152.
  3. 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.
  4. Sanford Guide to Antimicrobial Therapy 2014