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

XII. References

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

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Related Studies

Ontology: Daptomycin (C0057144)

Definition (MSH) A cyclic lipopeptide antibiotic that inhibits GRAM-POSITIVE BACTERIA.
Definition (NCI) A semi-synthetic cyclic lipopeptide antibiotic isolated form the bacterium Streptomyces roseosporus with broad-spectrum antibiotic activity against Gram-positive bacteria. Daptomycin has a distinct mechanism of action, in which it binds to bacterial membrane and causes rapid depolarization of the cell membrane due to calcium-dependant potassium efflux; the loss of membrane potential leads to inhibition of DNA, RNA and protein synthesis, resulting in bacterial cell death. This agent does not penetrate the outer membrane of gram-negative bacteria.
Definition (NCI_NCI-GLOSS) A drug used to treat certain bacterial skin and bloodstream infections in adults. Cubicin is also being studied in the treatment of fever and neutropenia (an abnormal decrease in the number of neutrophils, a type of white blood cell) in patients with cancer. It is a type of antibiotic.
Definition (PDQ) A semi-synthetic cyclic lipopeptide antibiotic isolated form the bacterium Streptomyces roseosporus with broad-spectrum anitbiotic activity against Gram-positive bacteria. Daptomycin has a distinct mechanism of action, in which it binds to bacterial membrane and causes rapid depolarization of the cell membrane due to calcium-dependant potassium efflux; the loss of membrane potential leads to inhibition of DNA, RNA and protein synthesis, resulting in bacterial cell death. This agent does not penetrate the outer membrane of gram-negative bacteria. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=469015&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=469015&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C47470" NCI Thesaurus)
Concepts Antibiotic (T195) , Amino Acid, Peptide, or Protein (T116)
MSH D017576
SnomedCT 406438001, 406439009
LNC LP33354-9, MTHU016673
English Daptomycin, Deptomycin, N-Decanoyl-L-tryptophyl-L-asparaginyl-L-aspartyl-L-threonylglycyl-L-ornithyl-L-aspartyl-D-alanyl-L-aspartylglycyl-D-seryl-threo-3-methyl-L-glutamyl-3-anthraniloyl-L-alanine epsilon1-lactone, N-decanoyl-L-tryptophyl-L-asparaginyl-L-aspartyl-L-threonylglycyl-L-ornithyl-L-aspartyl-D-alanyl-L-aspartylglycyl-D-seryl-threo-3-methyl-L-glutamyl-3-anthraniloyl-L-alanine-epsilon1-lactone, daptomycin (medication), Daptomycin [Chemical/Ingredient], DAPTOmycin, daptomycin, Daptomycin (product), Daptomycin (substance), DAPTOMYCIN
Swedish Daptomycin
Czech daptomycin
Finnish Daptomysiini
Russian DAPTOMITSIN, ДАПТОМИЦИН
Japanese ダプトマイシン
Polish Daptomycyna
Spanish daptomicina (producto), daptomicina (sustancia), daptomicina, Daptomicina
French Daptomycine
German Daptomycin
Italian Daptomicina
Portuguese Daptomicina

Ontology: Cyclic lipopeptide antibiotic (C1320334)

Concepts Antibiotic (T195) , Organic Chemical (T109)
SnomedCT 406437006, 406440006
Spanish lipopéptidos cíclicos, lipopéptidos cíclicos (producto), lipopéptidos cíclicos (sustancia), antibiótico lipopeptídico cíclico, antibiótico lipopeptídico cíclico (sustancia), antibiótico lipopeptídico cíclico (producto), antibióticos lipopéptidos cíclicos (producto), ántibióticos lipopéptidos cíclicos (sustancia), antibióticos lipopéptidos cíclicos, ántibióticos lipopéptidos cíclicos
English Cyclic lipopeptides, Cyclic lipopeptide antibiotic (product), Cyclic lipopeptide antibiotic (substance), Cyclic lipopeptide antibiotic, Cyclic lipopeptides (product), Cyclic lipopeptides (substance)

Ontology: Cubicin (C1330170)

Concepts Amino Acid, Peptide, or Protein (T116) , Antibiotic (T195)
MSH D017576
English Cubist Brand of Injectable Daptomycin, Cubicin