Cyclic Lipopeptide — MRSA / VRE / Bacteraemia / Endocarditis Pregnancy: Use with caution — limited human data; animal studies show no teratogenicity

Daptomycin

Brand names: Cubicin

Adult dose

Dose: Skin and soft tissue: 4 mg/kg IV once daily; Bacteraemia / right-sided endocarditis: 6 mg/kg IV once daily; Left-sided endocarditis (off-label high-dose): 8–12 mg/kg once daily

Route: Intravenous infusion over 30 minutes

Frequency: Once daily

Max: 12 mg/kg/day (specialist high-dose regimens)

Cyclic lipopeptide — disrupts gram-positive cell membrane by calcium-dependent insertion causing depolarisation. NOT active against gram-negatives. CRITICAL: inactivated by pulmonary surfactant — CANNOT be used for pneumonia. For right-sided endocarditis ONLY (not left-sided standard use).

Paediatric dose

Dose: 5–10 mg/kg mg/kg

Route: IV

Frequency: Once daily

Max: Specialist dosing — age-dependent

BNFc: licensed from 1 year of age; age-dependent dosing (older children/teens: 5–7 mg/kg; under 2: 10 mg/kg)

Dose adjustments

Renal

CrCl <30 mL/min: extend dosing interval to every 48 hours; haemodialysis: dose post-dialysis

Hepatic

No adjustment for mild-moderate hepatic impairment

Paediatric weight-based calculator

Patient weight (kg)

BNFc: licensed from 1 year of age; age-dependent dosing (older children/teens: 5–7 mg/kg; under 2: 10 mg/kg)

Clinical pearls

CRITICAL: daptomycin is NOT for pneumonia — pulmonary surfactant irreversibly binds and inactivates daptomycin; use vancomycin/linezolid for MRSA pneumonia
CK monitoring weekly (or twice weekly in renal failure) — myopathy is dose-dependent; stop if CK >5× ULN with symptoms or >10× ULN without symptoms; discontinue statins during course
MRSA bacteraemia: daptomycin 6 mg/kg has equivalent efficacy to vancomycin — preferred if vancomycin MIC is creeping (MIC ≥1.5)
Eosinophilic pneumonia: rare but serious — new pulmonary infiltrates + eosinophilia; stop daptomycin immediately
Mechanism: calcium-dependent insertion into gram-positive membrane → depolarisation → cell death; completely different from all other antibiotics

Contraindications

Hypersensitivity to daptomycin
Pulmonary infections (inactivated by surfactant)

Side effects

Myopathy/rhabdomyolysis (monitor CK — especially with statins)
Eosinophilic pneumonia (rare — dyspnoea, fever; stop immediately)
GI disturbance
Elevated LFTs
Peripheral neuropathy

Interactions

Statins — increased myopathy risk — suspend statins during daptomycin treatment
Tobramycin — may increase daptomycin levels (renal competition)
Warfarin — minor enhancement

Monitoring

CK weekly (mandatory)
Renal function
LFTs
FBC (eosinophilia)
Pulmonary symptoms (eosinophilic pneumonia)
Statin use (suspend during treatment)

Reference: BNFc; BNF 90; IDSA MRSA Guidelines 2011; MHRA SPC Cubicin; TARGET Trial (Daptomycin vs Vancomycin for MRSA Bacteraemia). Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways