Daptomycin

C difficile risk
Low
Oral Bioavailability
N/A

Dosing

For endocarditis or bloodstream infection: 6 - 10 mg/kg IV daily (doses up to 12 mg/kg may be appropriate in certain clinical scenarios, consult to infectious disease recommended)

For non-bloodstream infections: 4 - 6 mg/kg IV daily

Note: Daptomycin should only be used when other formulary agents (eg. vancomycin, linezolid, or other beta-lactam antibiotics) cannot be used due to resistance, allergy or severe intolerance, or treatment failure.

0 - 30 eGFR50+ eGFRGive dose q48hRegular dosing

General Information

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

Do NOT use for the treatment of pneumonia.

Pregnancy:

  • Information on daptomycin in pregnancy is limited.

  • No adverse effects were observed in three infants whose mothers had been treated with daptomycin, two in the second trimester and the other in the third trimester of pregnancy.

  • Adverse events or congenital malformations were not observed in animal reproduction studies.

Breastfeeding:

  • Very limited information indicates that daptomycin produces very low levels in milk.

  • Daptomycin is also poorly orally absorbed.

  • There were no adverse effects reported in infants of two case reports of breastfeeding mothers who received daptomycin 500 mg IV daily (one for 2 weeks, one for 4 weeks).

Creatine kinase weekly.

  • Myopathy including rhabdomyolysis

  • GI side effects common

  • Rash

  • Phlebitis

  • Increased INR

Statins and fibrates: monitor creatine kinase or hold while on daptomycin therapy (increased myopathy)

Higher doses used for endovascular infection.

Inactivated by pulmonary surfactant and therefore should not be used for pulmonary infections.

Antimicrobial class: Cyclic lipopeptide, depolarizes bacterial cell membrane