Daptomycin

Restricted
C. diff Risk

Low

Oral Bioavailability

NA

Spectrum Of Activity

Dosing

Unknown for severe hepatic dysfunction

Restricted to Infectious Disease physicians OR or patients with documentation of one of BMH's approved criteria for use

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

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

CrCl ≥ 30 ml/minCrCl < 30 ml/minNo dose adjustment necessaryBacteremia
6 mg/kg every 48 hr

Skin and soft tissue infections
4 mg/kg every 48 hr

Dose the same as in CrCl < 30 ml/minGive dose after HD on dialysis days

8mg/kg IV q48h

General Information

  • Gram positive infection resistant to beta-lactams and a serious vancomycin allergy (e.g. anaphylaxis, hives)

  • Failing vancomycin therapy - clinical decompensation or failure after at least 7 days therapy despite adequate source control and trough levels

  • VRE infection requiring IV therapy (when oral linezolid is unacceptable)

  • Staphylococcus infection with vancomycin MIC >2

  • Transition of therapy to facilitate discharge - single dose use (in patients not going to a SNF)

  • 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

Higher doses used for endovascular infection.

Recommend Infectious Disease Consult.

Inactivated by pulmonary surfactant and therefore insufficient for pulmonary infection.

  • GI side effects common

  • Rash

  • Phlebitis

  • Increased INR

  • Myopathy including rhabdomyolysis

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

Lab

  • Weekly creatinine kinase

  • Periodic SCr

Clinical

  • Muscle pain or weakness

  • GI effects

  • Hypersenistivity

  • Peripheral neuropathy

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: 9 hours

CSF penetration: Poor

Lung penetration: Poor

Urine penetration: Therapeutic