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Daptomycin

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  • Cyclic lipopeptide antibiotic
  • NB should not be used for treatment of pneumonia

Mode of action

  • exact mode of action unclear
  • binds to cell membrane and forms an ion conduction structure
    • thought that this allows rapid depolarization of the cell membrane due to potassium efflux and that this associated with a disruption of DNA, RNA and protein synthesis resulting in death
  • unable to penetrate outer membrane of gram negative organisms

Spectrum of activity

  • Gram positive organisms only. Includes:
    • Staphylococcus aureus
      • MSSA
      • MRSA
      • VRSA
    • Enterococcus spp including:
      • ampicillin and vancomycin resistant enterococci
    • Streptococcus spp including:
      • penicillin resistant Strep pneumoniae

Pharmacokinetics

  • IV administration
  • 92% plasma protein bound
    • low volume of distribution
    • poor penetration into alveolar lining fluid
  • 78% excreted via kidney
    • reduce dose for patients with creatinine clearance <30 ml/min
    • ~15% of dose removed by 4 h of haemodialysis
  • concentration-dependent killing
  • significant post antibiotic effect

Clinical uses

  • complicated skin and soft tissue infections due to susceptible organisms
  • should not be used for pneumonia

Adverse effects

  • risk of myopathy is major adverse effect
    • monitor creatine kinase

Further reading

Carpenter CF, Chambers HF. Daptomycin: another novel agent for treating infections due to drug-resistant gram-positive pathogens. Clinical Infectious Diseases, 2004; 38:994-1000

 

 

©Charles Gomersall, October, 2009 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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