Daptomycin

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Definition
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Antibiotic from the class of cyclic lipopeptides with bactericidal activity, especially against gram-positive pathogens. Reserve antibiotic for infections with multi-resistant Gram-positive pathogens (e.g. MRSA, vancomycin-resistant enterococci [VRE]). The penetration into the lung is comparatively poor, so that only low concentrations of the active substance are reached in the lung. Daptomycin is therefore not suitable for the treatment of patients with pneumonia. The elimination of the active substance is mainly renal!

Pharmacodynamics (Effect)
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Daptomycin is a cyclic lipopeptide which penetrates the bacterial cytoplasmic membrane via a lipid side chain and forms pores (ion channels) in the presence of calcium, which lead to potassium outflow, membrane depolarization and thus to rapid bactericide.

Spectrum of action
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The spectrum of action is limited to Gram-positive pathogens (streptococci, enterococci and staphylococci) including MRSA, VRSA and VRE. S.a.u. multiresistance.

Indication
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  • Approved in adults for the treatment of complicated skin and soft tissue infections (e.g. postoperative wound infections, superinfections in burns and abscesses).
  • Also approved for the therapy of right-sided infective endocarditis due to Staphylococcus aureus infections.
  • Also used for mixed infections where Gram-negative and/or certain anaerobic bacteria are suspected, in combination with suitable antibacterial agents that are effective against anaerobes according to the antibiogram.

Pregnancy/nursing period
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Do not use in pregnant women (insufficient data available) unless medically indicated (positive risk-benefit assessment). Do not use while breast-feeding (insufficient data).

Dosage and method of use
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  • Complicated skin and soft tissue infections without concomitant Staphylococcus aureus bacteremia: once/day 4 mg/kg bw i.v. (over 30 minutes) for 7-14 days or until the infection subsides.
  • Complicated skin and soft tissue infections with concurrent Staphylococcus aureus bacteremia: once/day 6 mg/kg bw i.v. (over 30 minutes) for 7-14 days or longer if necessary.
  • Known or suspected right-sided infective endocarditis due to Staphylococcus aureus: once/day 6 mg/kg bw i.v. (over 30 minutes).

Notice! Dose adjustment in case of advanced renal insufficiency is necessary (GFR < 80 ml/min.)!

Undesirable effects
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Common: drug exanthema, myopathies (muscle pain, muscle sensitivity, muscle weakness or muscle cramps) and CK increase, renal insufficiency, nausea, vomiting, diarrhea, mycoses.

Preparations
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Cubicin

Literature
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  1. Breen JO (2010) Skin and soft tissue infections in immunocompetent patients. On Fam Physician 81: 893-899
  2. Chamberlain RS et al (2009) Daptomycin for the treatment of surgical site infections. Surgery. 146: 316-324
  3. Draenert R, Bogner JR (2009) New antibiotics: small or big advances? Internist (Berl) 50: 1282, 1284-1288
  4. Friedman BC et al (2010) A retrospective review of clinical experience with daptomycin for a variety of wound types in a burn and wound care facility. South Med J 103: 748-752
  5. Kinney KK (2010) Treatment of infections caused by antimicrobial-resistant gram-positive bacteria. On J Med Sci 340: 209-217
  6. Siegman-Igra Y, Talan DA (2006) Therapy for methicillin-resistant Staphylococcus aureus. N Engl J Med 355: 2153

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Last updated on: 29.10.2020