Daptomycin

Restricted
Restricted

C. diff Risk

Low

Oral Bioavailability

NA

Approximate Cost

Dosing

Adult

Requires Infectious Disease consultation for use OR completion of the Restricted Antimicrobial order form for approved indications

Endocarditis or bloodstream infection
6-10mg/kg IV every 24 hr

Skin and soft tissue infections
4mg/kg IV every 24 hr

Hepatic

Unknown for severe hepatic dysfunction

General Information

Acceptable Uses

  • Endocarditis or bacteremia caused by MRSA in a patient with a serious allergy to vancomycin

  • Therapy for MRSA infections (other than penumonia) in which the MIC of vancomycin is ≥ 2 mcg/ml

  • Endocarditis or bacteremia caused by MRSA in a patient failing therapy with vancomycin (defined as decompensation after 3-4 days of therapy, or failure to clear blood cultures after 7-9 days despite adeqaute vancomycin levels)

  • Therapy for VRE infections (other than pneumonia) when pathogen is resistant to linezolid

Unacceptable Uses

  • Treatment of pneumonia, as daptomycin is inactivated by pulmonary surfactant

  • Empiric therapy for gram positive infections

  • VRE colonization of the urine, respiratory tract, or wounds.

Common Usage

Targeted therapy of resistant gram positive infections with MRSA (particularly when MIC ≥ 2) and VRE including endovascular infection

Drug Monitoring

Lab

  • weekly creatinine kinase

  • periodic SCr

Clinical

  • Muscle pain or weakness

  • GI effects

  • Hypersenistivity

  • peripheral neuropathy

Adverse Effects

  • GI side effects common

  • Rash

  • Phlebitis

  • Increased INR

  • Myopathy including rhabdomyolysis

Major Interactions

Statins and fibrates - Increased myopathy. Monitor creatine kinase or hold while on daptomycin therapy.

Additional Information

Higher doses used for endovascular infection.

Recommend Infectious Disease Consult.

Inactivated by pulmonary surfactant and therefore insufficient for pulmonary infection.

Pharmacology

Antimicrobial class: Cyclic Lipopeptide.

Pregnancy category: B

Average serum half life: 9 hours

Urine penetration: Therapeutic

Lung penetration: Poor

CSF penetration: Poor