Daptomycin

• Gram-positive bacteria (broad-spectrum activity)

• Multidrug-resistant gram-positive bacteria

Daptomycin is used mainly for infections caused by

• Vancomycin- and methicillin-resistant Staphylococcus aureus

• Vancomycin-resistant enterococci

However, methicillin-resistant S. aureus and vancomycin-resistant enterococci may become resistant during daptomycin therapy, resulting in relapsing or persistent infection.

daptomycin crosses the placenta is unknown. Depending on the indication and the severity of illness, using daptomycin during pregnancy may be reasonable.

• Eosinophilic pneumonia

• Myopathy

Chronic use may cause reversible organizing pneumonia with eosinophilic pulmonary infiltrates, presumably because daptomycin binds to pulmonary surfactant and thus accumulates in the alveolar spaces.

Skeletal myopathy due to daptomycin is often reversible but seldom occurs with once-a-day dosing. Nevertheless, rhabdomyolysis has been reported, and coadministration of daptomycin with other medications associated with myopathy, such as hydroxymethylglutaryl CoA reductase inhibitors (statins), may increase risk (1).

Dosing is adjusted for renal failure.

Because daptomycin can cause reversible skeletal myopathy, patients should be monitored for muscle pain or weakness, and serum creatine kinase levels should be checked weekly.