Antimicrobials

Active against:

• Staphylococcus, including methicillin-resistant Staphylococcus aureus (MRSA) and coagulase-negative Staphylococci
• Streptococcus
• Enterococcus, including vancomycin-resistant Enterococci (VRE)
• Corynebacterium
• Bacillus
• Gram-positive anaerobes such as: Clostridium perfringens, Finegoldia magna, Cutibacterium acnes

Not active against:

• Gram-negative organisms, including Gram-negative anaerobes

Appropriate uses

Treatment of the following MRSA, VRE or other susceptible Gram-positive infections in those who do not respond to or are not good candidates for vancomycin or linezolid (such as severe allergy or adverse effect).

• Bacteremia, including catheter-related
• Complicated skin and skin structure infections
• Endocarditis
• Intra-abdominal infections
• Osteomyelitis
• Prosthetic joint infections

Inappropriate uses

• Pneumonia: Daptomycin’s activity is inhibited by pulmonary surfactant
• Treatment of infections caused by susceptible Gram-positive organisms when patient does not have a contraindication to use a beta-lactam antibiotics or vancomycin

• Consider temporary discontinuation of “statin” drugs (HMG-CoA-reductase inhibitors) while receiving daptomycin as co-administration is associated with myopathy, unless a compelling need such as a recent cardiovascular event
• Patients with increased baseline creatine kinase (CK) may be at increased risk of further increases in CK
• The safety has not been established in patients with co-morbidities of musculopathies or neuropathies

• Myopathy associated with creatine phosphokinase (CK) elevations
• Peripheral neuropathy
• Eosinophilic pneumonia has been reported
• Hypersensitivity reactions

If CrCL ≥ 30 mL/min:

• Skin and skin structure infections: 4 to 6 mg/kg IV q24h
• Staphylococcus aureus bacteremia: 6 to 10 mg/kg IV q24h*

*Note: Doses as high as 8-12 mg/kg IV q24h have been used for indications such as infective endocarditis, osteomyelitis, prosthetic joint infections and infections caused by VRE

If CrCl < 30 mL/min:

• Same dose q48h
• Hemodialysis: Usual dose IV q48h or 10 mg/kg after every hemodialysis session
• Peritoneal dialysis: same dose q48h
• CRRT: usual dosage
• SLED: q24h post-SLED

• Signs and symptoms of myopathy (muscle pain or weakness, particularly in the distal extremities), pneumonitis or peripheral neuropathy
• CK as follows:
  • At baseline
  • Once weekly
  • Twice weekly if on doses > 8 mg/kg or on a “statin” (HMG-CoA reductase inhibitor) or if renal impairment or if experiences CK elevation
  • Every 2 days if muscle pain, tenderness, cramping or weakness

1. Streit JM, Jones RN, Sader HS. Daptomycin activity and spectrum: a worldwide sample of 6737 clinical Gram-positive organisms. J Antimicrob Chemo 2004;53:669-674.
2. Steenbergen JN, Alder J, Thorne GM, Tally FP. Daptomycin: a lipopeptide antibiotic for the treatment of serious Gram-positive infections. J Antimicrob Chemo 2005;55:282-288.
3. Cubicin®/Cubicin® RF (Daptomycin for Injection) Product Monograph. Cubist Pharmaceuticals LLC, Switzerland. Date of Revision: February 19, 2019.
4. Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin–resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011;52(3):1–38
5. Dare RK, Tewell C, Harris B et al. Effect of statin coadministration on the risk of daptomycin-associated myopathy. Clin Infect Dis 2018;67:1356
6. Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation 2015;132:1435-1486.