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Antibiotic — Lipopeptide Pregnancy: Avoid — insufficient safety data; use only in life-threatening infection with no alternative

Daptomycin (Burns — MRSA/VRE)

Brand names: Cubicin

Adult dose

Dose: Skin/soft tissue: 4 mg/kg IV once daily; Bacteraemia/endocarditis: 6–10 mg/kg IV once daily
Route: IV infusion over 30 min
Frequency: Once daily
Max: 10 mg/kg/day
Active against MRSA, VRE, and other resistant Gram-positive organisms. NOT active against Gram-negatives. NOT for pulmonary infections (inactivated by surfactant). Monitor CK — myopathy risk. Useful in burns with glycopeptide failure or intolerance.

Paediatric dose

Dose: 5–12 mg/kg
Route: IV
Frequency: Once daily
Max: Per weight-based calculation
Seek specialist opinion — dose varies by age: 1–6 years: 12 mg/kg; 7–11 years: 9 mg/kg; 12–17 years: 7 mg/kg. All once daily.

Dose adjustments

Renal

Reduce frequency to every 48 hours if eGFR <30 mL/min. Monitor CK more frequently.

Hepatic

No dose adjustment required.

Paediatric weight-based calculator

Seek specialist opinion — dose varies by age: 1–6 years: 12 mg/kg; 7–11 years: 9 mg/kg; 12–17 years: 7 mg/kg. All once daily.

Clinical pearls

  • Mandatory CK monitoring: weekly baseline and CK measurement. Stop if CK >5× ULN or myopathy symptoms develop.
  • Do NOT use for pneumonia — pulmonary surfactant inactivates daptomycin (failed in CAP trials)
  • Statin suspension during daptomycin course is essential — rhabdomyolysis risk is significant and documented

Contraindications

  • Pulmonary infections (inactivated by lung surfactant)
  • Hypersensitivity to daptomycin

Side effects

  • Myopathy and rhabdomyolysis (CK elevation)
  • Peripheral neuropathy
  • Eosinophilic pneumonia (rare)
  • GI disturbance
  • Elevated LFTs

Interactions

  • Statins (additive myopathy risk — suspend statin during daptomycin course)
  • Aminoglycosides (increased nephrotoxicity risk)
  • Warfarin (monitor INR)

Monitoring

  • CK levels at baseline then weekly
  • Renal function
  • Signs of peripheral neuropathy
  • Clinical response at 72 hours

Reference: BNFc; BNF 90; EUCAST/ESCMID Daptomycin Guidelines; BBA Burns Infection Guidelines; BNFc. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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