Cyclic Lipopeptide — MRSA / VRE / Bacteraemia / Endocarditis Pregnancy: eMC §4.6: no clinical data on pregnancies are available for daptomycin; animal studies do not indicate direct or indirect harmful effects with respect to pregnancy, embryonal/foetal development, parturition or postnatal development. Daptomycin should not be used during pregnancy unless clearly necessary, i.e. only if the expected benefit outweighs the possible risk. Breast-feeding: in a single human case study daptomycin 500 mg/day was given intravenously for 28 days to a nursing mother and the highest measured breast milk concentration was 0.045 mcg/ml, a low concentration; nevertheless, until more experience is gained, breast-feeding should be discontinued when daptomycin is administered. Fertility: no clinical data; animal studies do not indicate harmful effects on fertility.

Daptomycin

Brand names: Cubicin

Daptomycin is a cyclic lipopeptide antibacterial used for Gram-positive infections such as MRSA bacteraemia, right-sided infective endocarditis and complicated skin and soft-tissue infection. It is given once daily.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Complicated skin and soft-tissue infection (cSSTI) WITHOUT concurrent S. aureus bacteraemia: 4 mg/kg once every 24 hours. cSSTI WITH concurrent S. aureus bacteraemia, or known or suspected right-sided infective endocarditis due to S. aureus: 6 mg/kg once every 24 hours.

Route: Intravenous in 0.9% sodium chloride - in adults given either by infusion over a 30-minute period or by intravenous injection over a 2-minute period

Frequency: Once every 24 hours - daptomycin should not be used more frequently than once a day

eMC §4.2 (Daptomycin 350 mg powder for solution for infusion vial). DURATION: cSSTI without bacteraemia - 7 to 14 days or until the infection is resolved; cSSTI with S. aureus bacteraemia - may need to be longer than 14 days according to the perceived risk of complications in the individual patient; right-sided infective endocarditis - duration should be in accordance with available official recommendations. MONITORING: creatine phosphokinase (CPK) levels must be measured at baseline and at regular intervals (at least weekly) during treatment (§4.4). Clinical studies used infusion over at least 30 minutes; there is no clinical experience in patients of administration as an injection over 2 minutes (studied only in healthy subjects, with no clinically important differences in pharmacokinetics or safety versus 30-minute infusion). NOT FOR PNEUMONIA: clinical studies demonstrated that daptomycin is not effective in the treatment of pneumonia and it is not indicated for it (§4.4). §4.4 also states there is insufficient evidence regarding efficacy against enterococcal infections and that appropriate dose regimens for enterococcal infection have not been identified. HEPATIC IMPAIRMENT: no dose adjustment is necessary in mild or moderate impairment (Child-Pugh Class B); no data in severe impairment (Child-Pugh Class C) so caution should be exercised. ELDERLY: the recommended doses should be used except in those with severe renal impairment. PAEDIATRIC (1 to 17 years) - the per-kg dose differs by age band AND indication, so no single structured paediatric dose is given here. For cSSTI WITHOUT S. aureus bacteraemia: 12 to 17 years - 5 mg/kg once every 24 hours infused over 30 minutes; 7 to 11 years - 7 mg/kg once every 24 hours over 30 minutes; 2 to 6 years - 9 mg/kg once every 24 hours over 60 minutes; 1 to under 2 years - 10 mg/kg once every 24 hours over 60 minutes; duration up to 14 days. For cSSTI ASSOCIATED WITH S. aureus bacteraemia: 12 to 17 years - 7 mg/kg once every 24 hours over 30 minutes; 7 to 11 years - 9 mg/kg once every 24 hours over 30 minutes; 2 to 6 years - 12 mg/kg once every 24 hours over 60 minutes; 1 to under 2 years - 12 mg/kg once every 24 hours over 60 minutes; duration in accordance with the perceived risk of complications (mean 12 days, range 1 to 44 days in the paediatric SAB study). Children below the age of one year should NOT be given daptomycin because of the risk of effects on muscular, neuromuscular and/or nervous systems observed in neonatal dogs. The dosage regimen in paediatric patients with renal impairment has not been established. Safety and efficacy in patients under 18 years with right-sided infective endocarditis have not been established. Verify any under-18 use against a children's formulary.

Dose adjustments

Renal

eMC §4.2: daptomycin is eliminated primarily by the kidney and, because of limited clinical experience, should only be used in adults with any degree of renal impairment (CrCl below 80 ml/min) when the expected clinical benefit outweighs the potential risk; response to treatment, renal function and CPK should be closely monitored. cSSTI without S. aureus bacteraemia: CrCl 30 ml/min or above - 4 mg/kg once daily; CrCl below 30 ml/min - 4 mg/kg every 48 hours. Right-sided infective endocarditis or cSSTI associated with S. aureus bacteraemia: CrCl 30 ml/min or above - 6 mg/kg once daily; CrCl below 30 ml/min - 6 mg/kg every 48 hours. The same adjustments are recommended for adults on haemodialysis or continuous ambulatory peritoneal dialysis, and wherever possible daptomycin should be given after completion of dialysis on dialysis days. These interval adjustments are based on pharmacokinetic studies and modelling, not on controlled clinical trials. The dosage regimen in paediatric patients with renal impairment has not been established.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

Adult Patients · Administer to adult patients intravenously in 0.9% sodium chloride, either by injection over a 2-minute period or by infusion over a 30-minute period. ( 2.1 , 2.7 ) · Recommended dosage regimen for adult patients ( 2.2 , 2.4 , 2.6 ): Creatinine Clearance (CL CR ) Dosage Regimen cSSSI For 7 to 14 days S.aureus Bacteremia For 2 to 6 weeks ≥30 mL/min 4 mg/kg once every 24 hours 6 mg/kg once every 24 hours <30 mL/min, including hemodialysis and CAPD 4 mg/kg once every 48 hours* 6 mg/kg once every 48 hours* *Administered following hemodialysis on hemodialysis days. Pediatric Patients • Unlike in adults, do NOT administer by injection over a two (2) minute period to pediatric …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2023-04-19. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Hypersensitivity to the active substance or to any of the excipients (eMC §4.3)

Side effects

Serum creatine phosphokinase (CPK) increased (common) - CPK must be monitored at baseline and at least weekly; rhabdomyolysis is a less frequent but more serious reported reaction
Fungal infections, urinary tract infection and candida infection (common); Clostridium difficile-associated diarrhoea (frequency not known)
Gastrointestinal and abdominal pain, nausea, vomiting, constipation, diarrhoea, flatulence, bloating and distension (common)
Headache, dizziness, anxiety and insomnia (common); hypertension and hypotension (common); infusion site reactions, pyrexia and asthenia (common); anaemia (common)
Abnormal liver function tests - increased ALT, AST or alkaline phosphatase (common); rash and pruritus (common); limb pain (common). Less frequent but more serious: hypersensitivity reactions including angioedema and anaphylaxis, eosinophilic pneumonia (occasionally presenting as organising pneumonia), and DRESS

Interactions

HMG-CoA reductase inhibitors (statins) - US labelling §7.1: statins may cause myopathy with raised CPK, and in the adult S. aureus bacteraemia/endocarditis trial some patients on prior or concomitant statin therapy developed elevated CPK; experience of co-administration is limited, so consideration should be given to suspending statin use temporarily in patients receiving daptomycin
Drug/laboratory test interaction (eMC §4.4 and US §7.2): false prolongation of prothrombin time (PT) and elevation of INR has been observed when certain recombinant thromboplastin reagents are used for the assay - the effect is concentration-dependent and can be minimised by the timing of sampling
The eMC §4.5 interaction section was not captured in this bundle - clinician to review it in the full SPC

Clinical monograph

How it works

It binds the bacterial cell membrane in a calcium-dependent manner, causing rapid depolarisation and loss of membrane potential, which produces concentration-dependent bactericidal activity against Gram-positive organisms.

Prescribing in practice

It must not be used to treat pneumonia, because pulmonary surfactant inactivates the drug and it is ineffective at the lung.
It can cause myopathy with raised creatine kinase, so creatine kinase should be monitored and concurrent statin therapy reviewed and, where appropriate, suspended.
Rarely it causes eosinophilic pneumonia, which should be suspected if new or worsening breathlessness, fever and eosinophilia develop, prompting discontinuation.

Monitoring

Monitor creatine kinase at baseline and at least weekly during treatment, more often if there is muscle toxicity risk; monitor renal function and watch for new respiratory symptoms. Use within an antimicrobial stewardship framework.

Counselling the patient

Report any muscle pain, weakness or tenderness promptly.
Report new breathlessness, cough or fever during treatment.
Mention any statin or other cholesterol medicine you take so it can be reviewed.

Evidence & guidelines

An established option for MRSA bacteraemia and right-sided endocarditis; it is not indicated for pneumonia. Use should follow local antimicrobial guidance.

Reference: IDSA MRSA Guidelines 2011; MHRA SPC Cubicin; TARGET Trial (Daptomycin vs Vancomycin for MRSA Bacteraemia); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways