Daptomycin

Restricted
Restricted

C. diff Risk

Low

Oral Bioavailability

NA

Approximate Cost

$$$$

Dosing

Adult

Bacteremia or Endocarditis
6-10 mg/kg IV q24h

Skin and Soft Tissue Infections
4 mg/kg IV q24h

Hepatic

Unknown for severe hepatic dysfunction

Restricted Use

Infectious Diseases consultation required for use, per policy HS1444

General Information

Acceptable Uses

  • Bacteremia or endocarditis caused by MRSA or methicillin-resistant coagulase-negative staphylococci in a patient with a serious allergy to vancomycin

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

  • Bacteremia or endocarditis caused by MRSA in a patient failing vancomycin therapy defined as:

    • Clinical decompensation after 3-4 days
    • Failure to clear blood cultures after 7-9 days despite therapeutic vancomycin concentrations
    • Select cases in which the MIC of vancomycin is ≥ 2 mcg/ml
  • Salvage therapy for VRE infections other than pneumonia, on a case-by-case basis

Unacceptable Uses

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

  • Initial therapy for Gram-positive infections

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

  • Convenience due to ease of dosing compared to vancomycin. Clinical pharmacists and/or the Antimicrobial Stewardship Program pharmacists are available to assist with vancomycin dosing.

Common Usage

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

Drug Monitoring

Laboratory

  • CBC

  • CMP

  • CK weekly

  • Cr weekly (dose adjustment assessment)

Clinical

  • Hypersensitivity

  • GI effects

  • Myalgias

  • Rhabdomyolysis

Adverse Effects

  • Myopathy

  • GI effects

  • Hypersensitivity

  • Headache

  • Elevated CK

  • Myalgias

  • Rarely rhabdomyolysis

Major Interactions

Statins and Fibrates: Monitor creatine kinase or hold while on daptomycin therapy (increased myopathy)

Additional Information

Inactivated by pulmonary surfactant and therefore insufficient for pulmonary infection.

Pharmacology

Antimicrobial class: Cyclic lipopeptide. Depolarizes bacterial cell membrane.

Pregnancy category: B

Average serum half life: 9 hours

CSF penetration: Poor

Lung penetration: Poor

Urine penetration: Therapeutic