Antimicrobials
Daptomycin

Daptomycin

Low
N/A
$$$$

General Information

  • Bacteremia or endocarditis caused by MRSA or methicillin-resistant coagulase-negative staphylococci in a patient with a serious allergy to vancomycin (NOT Vancomycin Flushing Syndrome)

  • 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
  • Therapy for VRE infections other than pneumonia

  • 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.

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

Laboratory

  • CBC
  • CMP
  • CK once to twice weekly
  • Cr weekly (dose adjustment assessment)

Clinical

  • Hypersensitivity
  • GI effects
  • Myalgias
  • Rhabdomyolysis
  • Eosinophilic pneumonitis
  • Myopathy
  • GI effects
  • Hypersensitivity
  • Headache
  • Elevated CK
  • Myalgias
  • Rarely rhabdomyolysis

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

Inactivated by pulmonary surfactant and therefore insufficient for pulmonary infection.

Antimicrobial class: Cyclic lipopeptide. Depolarizes bacterial cell membrane.

Pregnancy category: B

Average serum half life: 9 hours

CSF penetration: Poor

Urine penetration: Therapeutic