Infectious Disease Compendium

Daptomycin (Cubicin®)

Dosing

CrCl Formula

CrCl > 30:

Skin and soft tissue: 4 mg/kg iv qd.

Endocarditis and bacteremia: 6-8-10 mg/kg iv qd. More is probably better for severe infections although one study suggests "Use of an empiric fixed dose of 750 mg of daptomycin is predicted to achieve a comparable PTA with a lower probability of toxicity as compared to the use of 10 mg/kg in critically ill patients (PubMed)."

8 mg/kg/day and even 10 mg/kg/d (PubMed) is safe, but is it more better? I think so (PubMed). For endocarditis and prosthetic joint infections I am inclined towards the higher doses and for Enterococcus and S. aureus.

For VRE, 9 mg/kg had outcomes (PubMed).

CrCl < 30 (PubMed):

Skin and soft tissue: 4 mg/kg iv qod.

Endocarditis and bacteremia: 6-8-10 mg/kg iv qod.

Hemodialysis:

Skin and soft tissue: 4 mg/kg iv qod.

Endocarditis and bacteremia: 6 mg/ks iv qod.

Peritoneal dialysis:

Skin and soft tissue: 4 mg/kg iv qod.

Endocarditis and bacteremia: 6 mg/ks iv qod.

Obesity dosing

Important side effects

Increase in CPK. Rare: eosinophilic pneumonia (PubMed). Although I have seen two cases.

Important drug interactions

One case of rhabdomyolysis (PubMed).

Rants and Screeds

Pearls

Treatment of choice

Use for

MRSA and streptococcal disease of all kinds. Cellulitis.

Don't use for

Pneumonia; no drug levels in the lung.

Class

Cyclic lipopeptide.