Drug reference
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.
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Complicated skin and soft-tissue infections caused by Gram-positive bacteria ▶BY INTRAVENOUS INFUSION ▶Child 12–23 months: 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: 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: 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: 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 Complicated skin and soft-tissue infections caused by Gram-positive bacteria ▶BY SLOW INTRAVENOUS INJECTION, OR BY INTRAVENOUS INFUSION ▶Adult: 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 by Staphylococcus aureus (administered on expert advice) ▶BY SLOW INTRAVENOUS INJECTION, OR BY INTRAVENOUS INFUSION ▶Adult: 6 mg/kg once daily, duration of treatment in accordance with official recommendations
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Obesity (limited information on safety and efficacy)
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Scottish Medicines Consortium (SMC) decisions SMC No. 248/06 ▶In adults The Scottish Medicines Consortium has advised (April 2006) that daptomycin (Cubicin ®) is accepted for restricted use within NHS Scotland for treatment of complicated skin and soft tissue infections in patients with known or suspected methicillin resistant Staphylococcus aureus infection and on the advice of local microbiologists or specialists in infectious disease. SMC No. 449/08 ▶In adults The Scottish Medicines Consortium has advised (March 2008) that daptomycin (Cubicin ®) is accepted for restricted use within NHS Scotland for the treatment of Staphylococcus aureus bacteraemia associated with right- sided endocarditis or with complicated skin and soft-tissue infections in patients with known or suspected methicillin resistant infection and on the advice of local microbiologists or specialists in infectious disease.
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→Appendix 1: daptomycin
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▶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). antibiotic associated colitis. chills. 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.
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Manufacturer advises use only if potential benefit outweighs risk—no information available.
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Present in milk in small amounts, but absorption from gastrointestinal tract negligible.
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Manufacturer advises caution in severe impairment—no information available.
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▶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 Use normal dose every 48 hours if eGFR less than 30 mL/minute/1.73 m2.
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▶Manufacturer advises monitor plasma creatine phosphokinase (CPK) before treatment and then at least weekly during treatment; monitor CPK more frequently in patients at higher risk of developing myopathy, including those with renal impairment, taking other drugs associated with myopathy, or if CPK elevated more than 5 times upper limit of normal before treatment. ▶Manufacturer advises monitor renal function regularly during concomitant administration of potentially nephrotoxic drugs. l EFFECT ON LABORATORY TESTS Interference with assay for prothrombin time and INR—take blood sample immediately before daptomycin dose.
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▶In children For intravenous infusion, manufacturer advises give intermittently in Sodium Chloride 0.9%; reconstitute with Sodium Chloride 0.9% (350 mg in 7 mL, 500 mg in 10 mL); gently rotate vial without shaking; allow to stand for at least 10 minutes then rotate gently to dissolve; dilute requisite dose in 50 mL infusion fluid and give over 60 minutes for children aged 1–6 years and over 30 minutes for children aged 7–17 years. ▶In adults For intravenous infusion, manufacturer advises give intermittently in Sodium Chloride 0.9%; reconstitute with Sodium Chloride 0.9% (350 mg in 7 mL, 500 mg in 10 mL); gently rotate vial without shaking; allow to stand for at least 10 minutes then rotate gently to dissolve; dilute requisite dose in 50 mL infusion fluid and give over 30 minutes. For intravenous injection, give over 2 minutes. l HANDLING AND STORAGE Manufacturer advises store in a refrigerator (2–8 °C)—consult product literature for further information regarding storage after reconstitution and dilution.
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There can be variation in the licensing of different medicines containing the same drug. Powder for solution for infusion ▶Daptomycin (Non-proprietary) Daptomycin 350 mg Daptomycin 350mg powder for solution for infusion vials | 1 vial P £60.00–£62.00 (Hospital only) Daptomycin 500 mg Daptomycin 500mg powder for solution for infusion vials | 1 vial P £88.00–£88.57 (Hospital only) ▶Cubicin (Merck Sharp & Dohme Ltd) Daptomycin 350 mg Cubicin 350mg powder for concentrate for solution for infusion vials | 1 vial P £62.00 (Hospital only) Daptomycin 500 mg Cubicin 500mg powder for concentrate for solution for infusion vials | 1 vial P £88.57 (Hospital only)
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10 mg/kg once daily for up to
First-line fragment. Read the complete Indications and Dose section above.
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9 mg/kg once daily for up to 14 days,
First-line fragment. Read the complete Indications and Dose section above.
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7 mg/kg once daily for up to 14 days,
First-line fragment. Read the complete Indications and Dose section above.
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5 mg/kg once daily for up to 14 days,
First-line fragment. Read the complete Indications and Dose section above.
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4 mg/kg once daily for 7–14 days or longer if
First-line fragment. Read the complete Indications and Dose section above.
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6 mg/kg once daily, duration of treatment in
First-line fragment. Read the complete Indications and Dose section above.
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