Antimicrobials
Daptomycin (Cubicin)

Daptomycin (Cubicin)

Restricted

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 with differential

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 (potentially increased myopathy)

Inactivated by pulmonary surfactant and therefore insufficient for pulmonary infection.

Antimicrobial class: Cyclic lipopeptide. Depolarizes bacterial cell membrane.

Average serum half life: 9 hours

CSF penetration: Poor

Urine penetration: Therapeutic