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Daptomycin​ prescribing guidance​



Introduction 
Daptomycin is a lipopeptide antibacterial agentDaptomycin is active via a calcium-dependent fast depolarisation of the bacterial cytoplasmic membrane, resulting in a rapid concentration-dependent bactericidal effect. This permits daptomycin to have bactericidal activity without being bacteriolytic. It is postulated that this reduces the pro-inflammatory bacterial fragments released.
Daptomycin is active against Gram-positive organisms only, including resistant pathogens such as MRSA and VRE, and anaerobes such as Clostridium perfringens and C. difficile. It can be used in combination with other antibiotics to obtain a broader spectrum of activity.
Daptomycin is a restricted antibiotic in the Trust and can only be initiated on the advice of microbiology or infectious diseases.


Indications
Licensed indications
  • Complicated skin and soft-tissue infections (cSSTI)  caused by Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA) ​
  • Adult patients with right sided endocarditis (RIE) due to S. aureus
  • Adult patients with S. aureus bacteraemia (SAB) when associated with RIE or cSSTI
Unlicensed indications​​ (on microbiology/infectious diseases advice)
​Can be considered for use to treat the following infections where alternative treatment options are limited or contraindicated: 
  • Bacteraemia or non-bacteraemic severe deep seated infections due to VRE, enterococcus faecium or enterococcus faecalis 
  • Endocarditis due to VRE, enterococcus faecium or enterococcus faecalis

Dose adjustments
Please refer to pharmacy or microbiology/infectious diseases for advice on dosing daptomycin.

Renal Impairment and Dialysis​

Renal impairment due to daptomycin is listed in the SPC as uncommon.

Monitor creatine kinase three times a week in renal impairment.

With deteriorating renal function there is an increased risk of side effects from daptomycin, such as rising creatine kinase and myopathy or eosinophilic pneumonitis. It is for this reason that dose adjustments are needed for daptomycin in renal failure.

    Hepatic Impairment

Manufacturer advises caution in severe hepatic impairment (no information available)

Monitoring

Monitor renal function.

Monitor creatine kinase before treatment and then weekly during treatment. Monitor creatine kinase three times a week in patients with renal impairment or if concerns with high doses. You do not need to wait for creatine kinase levels to be reported prior to administering daptomycin.

Daptomycin interacts with surfactant used in the laboratory process of determining INR giving falsely high readings. This can be addressed by taking blood for INR immediately prior to daptomycin dose or using point-of-care INR kits [1].

There is little data regarding interpretation of daptomycin levels: routine checking of this is not recommended.​ 

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