Daptomycin: Difference between revisions
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==General== | ==General== | ||
*Type: | *Type: bacterial [[antibiotic]] | ||
*Dosage Forms: | *Dosage Forms: IV | ||
*Common Trade Names: | *Common Trade Names: Cubicin | ||
*Good soft tissue and MSK penetration, but poor lung penetration as it is inactivated by pulmonary surfactant<ref>Estes KS and Derendorf K. Comparison of the pharmacokinetic properties of vancomycin, linezolid, tigecyclin, and daptomycin. Eur J Med Res. 2010; 15(12): 533–543.</ref><ref>Silverman JA et al. Inhibition of Daptomycin by Pulmonary Surfactant: In Vitro Modeling and Clinical Impact. J Infect Dis. (2005) 191 (12): 2149-2152.</ref> | |||
**Daptomycin is typically added to treat community enterococcus or [[vancomycin-resistant enterococcus]], but VRE pneumonia requires [[linezolid]] | |||
**Add MRSA antibiotic with adequate lung penetration such as [[linezolid]] at standard dosing or [[vancomycin]] dosing aimed at higher serum concentrations<ref>Stein GE and Wells EM. The importance of tissue penetration in achieving successful antimicrobial treatment of nosocomial pneumonia and complicated skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus: [[vancomycin]] and linezolid. Curr Med Res Opin. 2010 Mar;26(3):571-88.</ref> | |||
==Adult Dosing== | ==Adult Dosing== | ||
*Complicated bacterial skin infections: | |||
**4mg/kg q24h x7-14 days | |||
*Staph bacteremia: | |||
**6mg/kg IV q24h x2-6 wks | |||
*Renal dosing | |||
**CrCl <30, give q48h | |||
**HD: give dose after dialysis, no supplement | |||
**PD: no supplement | |||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
*Unavailable | |||
==Special Populations== | ==Special Populations== | ||
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: | *[[Drug Ratings in Pregnancy|Pregnancy Rating]]: B | ||
*Lactation: | *Lactation: Infant risk cannot be ruled out | ||
*Renal Dosing | *Renal Dosing | ||
**Adult | **Adult | ||
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==Contraindications== | ==Contraindications== | ||
*Allergy to class/drug | *Allergy to class/drug | ||
*CK > 10x upper limit normal | |||
*CK > 10x upper limit normal with myopathy | |||
*caution in elderly | |||
*caution in recent antibiotic-associated colitis | |||
==Adverse Reactions== | ==Adverse Reactions== | ||
===Serious=== | ===Serious=== | ||
*C. difficile diarrhea | |||
*Superinfection | |||
*Eosinophilic pneumonia | |||
*Anaphylaxis | |||
*Drug rash | |||
*Thrombocytopenia | |||
*Myopathy | |||
*Rhabdomyolysis | |||
*Peripheral neuropathy | |||
===Common=== | ===Common=== | ||
*Insomnia | |||
*Pharyngeal pain | |||
*Elevated CK | |||
*[[Chest pain]] | |||
*Edema | |||
*Abdominal pain | |||
*Pruritis | |||
*Headache | |||
*[[Diarrhea]] | |||
==Pharmacology== | ==Pharmacology== | ||
*Half-life: | *Half-life: 8-9 h | ||
*Metabolism: | *Metabolism: unknown | ||
*Excretion: | *Excretion: Urine 78% | ||
*Mechanism of Action: | *Mechanism of Action: Bactericidal, binds/depolarizes bacterial membranes | ||
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>== | ==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>== | ||
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==See Also== | ==See Also== | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:Pharmacology]] | |||
[[Category:ID]] |
Revision as of 23:52, 20 September 2019
General
- Type: bacterial antibiotic
- Dosage Forms: IV
- Common Trade Names: Cubicin
- Good soft tissue and MSK penetration, but poor lung penetration as it is inactivated by pulmonary surfactant[1][2]
- Daptomycin is typically added to treat community enterococcus or vancomycin-resistant enterococcus, but VRE pneumonia requires linezolid
- Add MRSA antibiotic with adequate lung penetration such as linezolid at standard dosing or vancomycin dosing aimed at higher serum concentrations[3]
Adult Dosing
- Complicated bacterial skin infections:
- 4mg/kg q24h x7-14 days
- Staph bacteremia:
- 6mg/kg IV q24h x2-6 wks
- Renal dosing
- CrCl <30, give q48h
- HD: give dose after dialysis, no supplement
- PD: no supplement
Pediatric Dosing
- Unavailable
Special Populations
- Pregnancy Rating: B
- Lactation: Infant risk cannot be ruled out
- Renal Dosing
- Adult
- Pediatric
- Hepatic Dosing
- Adult
- Pediatric
Contraindications
- Allergy to class/drug
- CK > 10x upper limit normal
- CK > 10x upper limit normal with myopathy
- caution in elderly
- caution in recent antibiotic-associated colitis
Adverse Reactions
Serious
- C. difficile diarrhea
- Superinfection
- Eosinophilic pneumonia
- Anaphylaxis
- Drug rash
- Thrombocytopenia
- Myopathy
- Rhabdomyolysis
- Peripheral neuropathy
Common
- Insomnia
- Pharyngeal pain
- Elevated CK
- Chest pain
- Edema
- Abdominal pain
- Pruritis
- Headache
- Diarrhea
Pharmacology
- Half-life: 8-9 h
- Metabolism: unknown
- Excretion: Urine 78%
- Mechanism of Action: Bactericidal, binds/depolarizes bacterial membranes
Antibiotic Sensitivities[4]
Key
- S susceptible/sensitive (usually)
- I intermediate (variably susceptible/resistant)
- R resistant (or not effective clinically)
- S+ synergistic with cell wall antibiotics
- U sensitive for UTI only (non systemic infection)
- X1 no data
- X2 active in vitro, but not used clinically
- X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
- X4 active in vitro, but not clinically effective for strep pneumonia
See Also
References
- ↑ Estes KS and Derendorf K. Comparison of the pharmacokinetic properties of vancomycin, linezolid, tigecyclin, and daptomycin. Eur J Med Res. 2010; 15(12): 533–543.
- ↑ Silverman JA et al. Inhibition of Daptomycin by Pulmonary Surfactant: In Vitro Modeling and Clinical Impact. J Infect Dis. (2005) 191 (12): 2149-2152.
- ↑ Stein GE and Wells EM. The importance of tissue penetration in achieving successful antimicrobial treatment of nosocomial pneumonia and complicated skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus: vancomycin and linezolid. Curr Med Res Opin. 2010 Mar;26(3):571-88.
- ↑ Sanford Guide to Antimicrobial Therapy 2014