Formulary
Daptomycin: Indications, Dosing, Side Effects and Interactions
Daptomycin is a lipopeptide antibacterial with a spectrum of activity similar to vancomycin but its efficacy against enterococci has not been established.
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Daptomycin: Indications, Dosing, Side Effects and Interactions
Daptomycin is a lipopeptide antibacterial with a spectrum of activity similar to vancomycin but its efficacy against enterococci has not been established.
Drug action
Daptomycin is a lipopeptide antibacterial with a spectrum of activity similar to vancomycin but its efficacy against enterococci has not been established. It needs to be given with other antibacterials for mixed infections involving Gram-negative bacteria and some anaerobes.
Indications and dose
**Complicated skin and soft-tissue infections caused by Gram-positive bacteria**
- **Adult** (By Slow Intravenous Injection, Or By Intravenous Infusion): 4 mg/kg once daily for 7-14 days or longer if necessary, alternatively 6 mg/kg once daily, higher dose only if associated with Staphylococcus aureus bacteraemia-duration of treatment may need to be longer than 14 days in accordance with risk of complications in individual patients.
**Right-sided infective endocarditis caused byStaphylococcus aureus(administered on expert advice)**
- **Adult** (By Slow Intravenous Injection, Or By Intravenous Infusion): Right-sided infective endocarditis caused by Staphylococcus aureus (administered on expert advice) 6 mg/kg once daily, duration of treatment in accordance with official recommendations.
**Complicated skin and soft-tissue infections caused by Gram-positive bacteria for daptomycin**
- **Child 12-23 months** (By intravenous infusion): 10 mg/kg once daily for up to 14 days, alternatively 12 mg/kg once daily, higher dose only if associated with Staphylococcus aureus bacteraemia-duration of treatment in accordance with risk of complications in individual patients.
- **Child 2-6 years** (By intravenous infusion): 9 mg/kg once daily for up to 14 days, alternatively 12 mg/kg once daily, higher dose only if associated with Staphylococcus aureus bacteraemia-duration of treatment in accordance with risk of complications in individual patients.
- **Child 7-11 years** (By intravenous infusion): 7 mg/kg once daily for up to 14 days, alternatively 9 mg/kg once daily, higher dose only if associated with Staphylococcus aureus bacteraemia-duration of treatment in accordance with risk of complications in individual patients.
- **Child 12-17 years** (By intravenous infusion): 5 mg/kg once daily for up to 14 days, alternatively 7 mg/kg once daily, higher dose only if associated with Staphylococcus aureus bacteraemia-duration of treatment in accordance with risk of complications in individual patients.
Cautions
Obesity (limited information on safety and efficacy)
Side effects
Common or very common Anaemia; anxiety; asthenia; constipation; diarrhoea; dizziness; fever; flatulence; gastrointestinal discomfort; headache; hypertension; hypotension; increased risk of infection; insomnia; nausea; pain; skin reactions; vomiting Uncommon Appetite decreased; arrhythmias; arthralgia; electrolyte imbalance; eosinophilia; flushing; glossitis; hyperglycaemia; muscle weakness; myalgia; myopathy; paraesthesia; renal impairment; taste altered; thrombocytosis; tremor; vertigo Rare or very rare Jaundice Frequency not known Acute generalised exanthematous pustulosis (AGEP); chills; Clostridioides difficile colitis; cough; infusion related reaction; peripheral neuropathy; respiratory disorders; syncope Side-effects, further information If unexplained muscle pain, tenderness, weakness, or cramps develop during treatment, measure creatine kinase every 2 days; discontinue if unexplained muscular symptoms and creatine elevated markedly.
Interactions
**Severe interactions:**
- The pharmacokinetics of daptomycin were not significantly altered by aztreonam.
- Although small changes in the pharmacokinetics of daptomycin and tobramycin were observed during coadministration by intravenous infusion over a 30-minute period using a daptomycin dose of 2 mg/kg,...
**Other interactions (16):**
- Daptomycin undergoes little to no Cytochrome P450 (CYP450)-mediated metabolism.
- Interaction studies for daptomycin were performed with aztreonam, tobramycin, warfarin and probenecid.
- Daptomycin had no effect on the pharmacokinetics of warfarin or probenecid, nor did these medicinal products alter the pharmacokinetics of daptomycin.
- The interaction between daptomycin and tobramycin with an approved dose of daptomycin is unknown.
- Caution is warranted when daptomycin is co-administered with tobramycin.
- Experience with the concomitant administration of daptomycin and warfarin is limited.
Pregnancy
Manufacturer advises use only if potential benefit outweighs risk-no information available.
Breast feeding
Present in milk in small amounts, but absorption from gastrointestinal tract negligible.
Hepatic impairment
Manufacturer advises caution in severe impairment-no information available.
Renal impairment
In children: Manufacturer advises the dosage regimen has not been established-use with caution and monitor renal function regularly. In adults: Manufacturer advises use only when potential benefit outweighs risk-higher risk of developing myopathy; monitor renal function regularly. Dose adjustments In adults: Manufacturer advises use normal dose every 48 hours if creatinine clearance less than 30 mL/minute. See Prescribing in renal impairment .
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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