Clinical Indications
Inpatient Complicated Skin and Soft Tissue Infection (cSSTI) Due to Staphylococcus Aureus (see Cellulitis, [[Cellulitis]])
- Definition of cSSTI
- Cellulitis
- Deeper Soft Tissue Infection
- Infected Ulcers/Burns
- Major Abscess
- Surgical/Traumatic Wound Infection
- Recommendations
- One of the Recommended Agents for the Treatment of Inpatient cSSTI Due to Methicillin-Resistant Staphylococcus Aureus (MRSA) (Infectious Diseases Society of America 2011 Guidelines for the Treatment of MRSA) (Clin Infect Dis, 2011) [MEDLINE]
Uncomplicated/Complicated Bacteremia Due to Staphylococcus Aureus
- Definition of Uncomplicated Bacteremia
- Positive Blood Cultures for MRSA
- Exclusion of Endocarditis
- No Implanted Prosthetics
- Follow-Up Negative Blood Cultures 2-4 Days After Initial Set
- No Metastatic Foci of Infection
- Defervescence within 72 hrs of Initiating Effective Therapy
- Definition of Complicated Bacteremia
- Patients with Positive Blood Cultures for MRSA Who Do Not Meet the Criteria for Uncomplicated Bacteremia
- Recommendations
- One of the Recommended Agents for the Treatment of Bacteremia Due to Methicillin-Resistant Staphylococcus Aureus (MRSA) (Infectious Diseases Society of America 2011 Guidelines for the Treatment of MRSA) (Clin Infect Dis, 2011) [MEDLINE]
Native Valve Infective Endocarditis Due to Staphylococcus Aureus (see Endocarditis, [[Endocarditis]])
- Recommendations
- One of the Recommended Agents for the Treatment of Native Valve Infective Endocarditis Due to Methicillin-Resistant Staphylococcus Aureus (MRSA) (Infectious Diseases Society of America 2011 Guidelines for the Treatment of MRSA) (Clin Infect Dis, 2011) [MEDLINE]
Microbial Coverage
Staphylococcus Aureus (see Staphylococcus Aureus, [[Staphylococcus Aureus]])
- Methicillin-Sensitive Staphylococcus Aureus (MSSA)
- Methicillin-Resistant Staphylococcus Aureus (MRSA)
Streptococcus (see Streptococcus, [[Streptococcus]])
Enterococcus (see Enterococcus, [[Enterococcus]])
- Vancomycin-Resistant Enterococcus (VRE) (see Enterococcus, [[Enterococcus]])
Pharmacology
- Cyclic Lipopeptide
- Mechanism: calcium-dependent depolarization of bacterial cell wall (due to the lipophilic tail of the drug inserting itself into the bacterial membrane, forming a channel in the membrane -> potassium efflux)
Metabolism
- Renal: 80% excreted unchanged via kidneys
- Pharmacokinetics
- Elimination Half-Life: 8 hrs
Drug Penetration
- Cerebrospinal Fluid (CSF): poor, even with meningeal inflammation
Administration
- IV (Complicated Skin/Skin Structure Infections): 4 mg/kg IV qday
- IV (Bacteremia/Endocarditis): 6 mg/kg IV qday
Dose Adjustment
- Hepatic: none (for mild-moderate liver disease)
- Renal
- CrCl <30 ml/min: decrease dosing frequency to q48 hrs
- Hemodialysis: give dose after hemodialysis
Drug Interactions
- HMG-CoA Reductase Inhibitors (see HMG-CoA Reductase Inhibitors, [[HMG-CoA Reductase Inhibitors]]): concomitant use increases risk of creatine kinase elevation and myopathy
Adverse Effects
Gastrointestinal Adverse Effects
Hematologic Adverse Effects
- Neutropenia (see Neutropenia, [[Neutropenia]])
- Epidemiology: associated with prolonged daptomycin administration
- Treatment: reversible with discontinuation of daptomycin
Pulmonary Adverse Effects
Rheumatologic/Orthopedic Adverse Effects
- Muscle-Related Complications: usually begin within one week of starting therapy
- Elevated Creatine Kinase (see Serum Creatine Kinase, [[Serum Creatine Kinase]]): occurs in 2.8% of cases
- Myopathy (see Myopathy, [[Myopathy]]): symptomatic myopathy occurs in 0.2% of cases
- Myalgias (see Myalgias, [[Myalgias]])
- Rhabdomyolysis (see Rhabdomyolysis, [[Rhabdomyolysis]]): case reports
- Treatment: discontinue daptomycin -> symptoms usually resolve in 2-3 days
- Creatine kinase elevation may persist for up to 2 wks
Other Adverse Effects
- Injection Site Reaction: occurs in 6% of cases
References
- Two cases of daptomycin-induced eosinophilic pneumonia and chronic pneumonitis. Clin Infect Dis. 2010 Mar 1;50(5):737-40. doi: 10.1086/650487 [MEDLINE]