Daptomycin
CUBICIN
What it isLipopeptide that depolarizes Gram-positive bacterial membranes; MRSA bacteremia, endocarditis, and skin infection.
Why this oneIts rapid bactericidal activity is especially valuable in MRSA bacteremia and endocarditis when vancomycin fails.
What limits it⚑ Pulmonary surfactant inactivates it, so it does not treat pneumonia. Monitor creatine kinase for myopathy; eosinophilic pneumonia can occur.
FDA-approved for
- complicated skin infection and S. aureus bacteremia (2003)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Complicated skin and skin structure infections (cSSSI) | Adults | 4 mg/kg q24h | 4 mg/kg q24h | 4 mg/kg q24h |
| S. aureus bacteremia | Adults | 6 mg/kg q24h | 6 mg/kg q24h | 6 mg/kg q24h |
| cSSSI | Pediatric 1-17 yr | 5-10 mg/kg q24h by age (12-17y 5; 7-11y 7; 2-6y 9; 1-<2y 10) | per age | 10 mg/kg q24h |
| S. aureus bacteremia | Pediatric 1-17 yr | 7-12 mg/kg q24h by age (12-17y 7; 7-11y 9; 1-6y 12) | per age | 12 mg/kg q24h |
Renal CrCl <30 mL/min (incl. hemodialysis/CAPD): dose q48h, given after dialysis on dialysis days (adults). Pediatric renal-impairment dosing not established.
Hepatic Undefined
cSSSI duration 7-14 days; S. aureus bacteremia 2-6 weeks (adults).
Instructions
- Adults: IV over 2 min (injection) or 30 min (infusion) in 0.9% NaCl.
- Pediatrics: do NOT give by 2-min injection; infuse over 30-60 min by age.
- Do not use with ReadyMED elastomeric infusion pumps.
- Avoid in pediatric patients <12 months.
Cautions
- Anaphylaxis/hypersensitivity (including life-threatening)
- Myopathy and rhabdomyolysis — monitor CPK
- Eosinophilic pneumonia
- DRESS
- Tubulointerstitial nephritis
- Peripheral neuropathy
- Reduced efficacy with moderate baseline renal impairment
- C. difficile-associated diarrhea
Adverse reactions
- Diarrhea
- Headache
- Dizziness
- Rash
- Elevated CPK
- Abnormal LFTs
- UTI
- Hypotension
Pregnancy Insufficient data; no adverse developmental outcomes in animal studies.
Lactation Present in human milk at ~0.1% of maternal dose; consider benefits vs. clinical need.
NO BOXED WARNINGS
Principal riskInactivated by surfactant, so it does not treat pneumonia
Cost, est. cash$300–$2,500/month
Generic entryLong generic
Classes and tags
Clinical profile
Legacy pregnancy categoryB
Defining liabilityAllergy, gastrointestinal effects and agent-specific renal, hepatic, hematologic or interaction risks.
Mechanism of action: Daptomycin ballicule
