Restricted
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:
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