Dosing
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. And bone levels are good (PubMed).
For VRE, 9 mg/kg had better 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.
Important side effects
Increase in CPK. The risk goes up with statins (PubMed). Or does it? Another study says nope: "Concomitant use of daptomycin and statin did not show an increased risk of CPK elevation. Clinicians may consider concomitant use of daptomycin and statin therapy with weekly CPK monitoring." (Pubmed). Better studies trump poorer studies, right?
Rare: eosinophilic pneumonia (PubMed). Although I have seen two cases.
Important drug interactions
One case of rhabdomyolysis (PubMed).
Rants and Screeds
Pearls
Resistance can occur on therapy, in part a cross-reaction to resistance to platelet-derived cationic proteins (PubMed).
Treatment of choice
Use for
MRSA and streptococcal disease of all kinds. Cellulitis. VRE.
Don't use for
Pneumonia; no drug levels in the lung alveoli.
But some data suggests it is ok for Staphylococcal septic emboli from endocarditis (PubMed), which is my experience.
Class
Cyclic lipopeptide.
Curious Cases
Relevant links to my Medscape blog
Last Update: 11/16/19.