Daptomycin

Aka: Daptomycin, Cubicin, Cyclic Lipopeptide, Lipopeptide

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II. Indications

  1. Organisms
    1. Methicillin-Resistant Staphylococcus aureus (MRSA)
    2. Streptococcal Species
    3. Vancomycin Sensitive Enterococcus
  2. Conditions
    1. Complicated Skin Infections
    2. Endocarditis
    3. Do not use for Pneumonia
      1. Poorly penetrates lung
      2. Inactivated by surfactant

III. Mechanism

  1. Cyclic Lipopeptide
  2. Depolarizes Bacterial cell membrane

IV. Dosing: Adult

  1. Complicated Skin Infections including MRSA
    1. Daptomycin 4 mg/kg in NS IV over 30 minutes once daily for 7 to 14 days
  2. Right sided endocarditis due to Staphylococcus aureus
    1. Daptomycin 6 mg/kg in NS IV over 30 minutes once daily for 2 to 6 weeks
    2. AHA/IDSA guideline allows for injection over 2 minutes as alternative to infusion (not FDA approved)
  3. MRSA Bacteremia (or Endocarditis) High Dose regimen (not FDA approved)
    1. Daptomycin 6 to 8 mg/kg in NS IV over 30 minutes once daily for 2 to 6 weeks
  4. Left sided MSSA Endocarditis (AHA, not FDA approved)
    1. Daptomycin 8 mg/kg in NS IV over 30 minutes once daily for up to 6 weeks
  5. Multi-drug Resistant Enterococcal Endocarditis (AHA, not FDA approved, consult infectious disease)
    1. Daptomycin 10 to 12 mg/kg in NS IV over 30 minutes once daily for up to 6 weeks
  6. Vancomycin-Resistant MRSA Bacteremia (not FDA approved)
    1. Daptomycin 10 mg/kg in NS IV over 30 minutes once daily for up to 6 weeks
  7. MRSA Osteomyelitis
    1. Daptomycin 6 mg/kg in NS IV over 30 minutes once daily
  8. Renal Dosing (eGFR <30 ml/min or Hemodialysis)
    1. eGFR <30 ml/min: 4 mg/kg IV every 48 hours for Skin Infections (6 mg/kg for s. aureus bacteremia)
    2. Daptomycin efficacy may be lower when eGFR <50 ml/min

V. Dosing: Child

  1. Complicated Skin Infections including MRSA
    1. Age 12 to 17 years: Daptomycin 5 mg/kg in NS IV over 30 minutes once daily for 7 to 14 days
    2. Age 7 to 11 years: Daptomycin 7 mg/kg in NS IV over 30 minutes once daily for 7 to 14 days
    3. Age 2 to 6 years: Daptomycin 9 mg/kg in NS IV over 30 minutes once daily for 7 to 14 days
    4. Age 1 to 2 years: Daptomycin 10 mg/kg in NS IV over 30 minutes once daily for 7 to 14 days
  2. Staphylococcus aureus bacteremia (endocarditis)
    1. Age 12 to 17 years: Daptomycin 7 mg/kg in NS IV over 30 minutes once daily for up to 6 weeks
    2. Age 7 to 11 years: Daptomycin 9 mg/kg in NS IV over 30 minutes once daily for up to 6 weeks
    3. Age 1 to 6 years: Daptomycin 12 mg/kg in NS IV over 60 minutes once daily for up to 6 weeks

VI. Pharmacokinetics

  1. Renal excretion (most is excreted unchanged)
  2. Protein bound 92%
  3. Half-Life: 9 hours

VII. Adverse Effects

  1. Muscle toxicity or Myopathy
    1. Avoid concurrent Statin use
  2. Neuropathy
  3. Eosinophilic Pneumonia (rare)
  4. Hepatotoxicity
  5. Diarrhea
  6. Rash

VIII. Safety

  1. Pregnancy Category B
  2. Unknown safety in Lactation

IX. Drug Interactions

  1. INR
    1. False elevation of PT/INR

X. Monitoring

  1. Weekly labs while on Daptomycin
    1. Renal Function (if renal Impairment)
    2. Serum CPK
      1. Stop Daptomycin if Myopathy symptoms and CPK >5x upper limit of normal
      2. Stop Daptomycin if NO Myopathy symptoms and CPK >10x upper limit of normal

XI. Resources

  1. Daptomycin (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=1957b6ce-7382-4a7b-bf02-3595948d09c6
  2. Daptomycin (StatPearls)
    1. https://www.ncbi.nlm.nih.gov/books/NBK470407/

XII. References

  1. (2004) Med Lett Drugs Ther 46(1175): 11-2
  2. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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