Antimicrobials
Daptomycin

Daptomycin

Low
N/A

Spectrum of Activity

General Information

Administration

  • IV infusion over 30 minutes

  • May do IV push over 2 minutes

  • Can NOT be used with ReadyMED elastomeric infusion pumps due to chemical leaching into daptomycin solution

Preparation

  • Cubicin: Reconstitute with 10mL NS (concentration 50mg/mL)

  • Cubicin-RF: reconstitute with 10mL SWFI or bacteriostatic water (concentration 50mg/mL)

  • Daptomycin 350mg vial: reconstitute with 7mL NS (concentration 50mg/mL)

  • Gently swirl and rotate vial to wet powder and allow to sit until completely reconstituted. Do not shake or agitate

  • Further dilute in 50mL of NS

Compatibility

  • NS or LR

  • Incompatible in D5W

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

Tier Three

  • Last line option, but will be used more commonly in practice for specific cases of 1st line option inadequacy

  • Strategies used: ASP Prospective Audit with Feedback, Criteria-for-use

  • Appropriate use for sepsis, bacteremia or cellulitis when vancomycin dosing concern for AKI

  • Creatine phosphokinase weekly (also muscle pain/weakness or worsening peripheral neuropathy)

  • Signs/symptoms of eosinophilic pneumonia

  • Can get trough concentrations at steady-state (not recommended) or Cmax:MIC ratios

  • GI side effects common

  • Rash

  • Phlebitis

  • Increased INR

  • Myopathy including rhabdomyolysis

  • Chest pain

  • Edema

  • gram negative infections

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

Antimicrobial class: Cyclic Lipopeptide.

Pregnancy category: B

Average serum half life: 8-9 hours

Urine penetration: Therapeutic

Lung penetration: Poor

CSF penetration: Poor

Bone penetration: Poor to therapeutic

Cubicin, Cubicin-RF

Higher doses used for endovascular infection.

Recommend Infectious Disease Consult.

Inactivated by pulmonary surfactant and therefore insufficient for pulmonary infection.