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Part III: Guidelines for Selected Antimicrobial Use



3.3 Daptomycin



  1. Daptomycin is a lipopeptide antibiotic.

  2. It is only active against Gram-positive bacteria with in vitro activity includes MSSA and MRSA, VRE, methicillin-resistant Staphylococcus epidermidis, Streptococcus pyogenes and other streptococci. [174,175]

  3. It can be used to treat complicated skin and soft tissue infections (cSSTI), S. aureus bloodstream infections, including right-sided infective endocarditis. It should not be used to treat pneumonia since it is inactivated by lung surfactant. [176]

  4. Microbiologic failure has been reported in patients with S. aureus bacteraemia with or without endocarditis and who received daptomycin monotherapy. [177]

  5. The optimal dosage of daptomycin is being updated and should be tailored based on the infecting pathogen, MIC distribution, and type of infection. [178–180] Higher doses (8–12 mg/kg/day) have been used in serious infections like bacteraemia, endocarditis, and osteomyelitis. [19,181–187] Higher doses have been associated with increased rate of elevated serum creatine kinase. [180]

  6. Dosing

Adults with creatinine clearance (CrCl) greater than or equal to 30 mL/min

cSSTI: 4 mg/kg once every 24 hours

S. aureus bacteraemia: 8–10 mg/kg once every 24 hours [19,181,187]

Adults with kidney impairment

Reduction in dosing is required in patients with CrCl <30 mL/min, including haemodialysis and continuous ambulatory peritoneal dialysis (CAPD). Please refer to drug package insert and/or drug information database for the latest recommendation.

Adults with liver impairment

The pharmacokinetics of daptomycin in patients with severe hepatic impairment (Child-Pugh Class C) have not been evaluated. [188]

  1. Adverse reactions (non-exhaustive)

Myopathy and rhabdomyolysis

Watch out for muscle pain, weakness

Monitor serum creatine kinase

More frequent monitoring when higher doses are used

HMG-CoA reductase inhibitors (i.e. statins, e.g. atorvastatin, rosuvastatin, and simvastatin) were associated with daptomycin-related myopathy and rhabdomyolysis in meta-analysis. [189] Consider temporarily suspending statin in patients receiving daptomycin. [189]

Eosinophilic pneumonia [190]

Immune thrombocytopaenia [191]

  1. Please consult a clinical microbiologist or infectious disease physician for the use of daptomycin.



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