### Dosing **For 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." [^1] 8 mg/kg/day and even 10 mg/kg/d is safe, but is it more better? [^2] I think so. It is true for beer and ice cream, so my not [[daptomycin]]? [^3] For [[endocarditis]] and [[Prosthetic Joint Infections]], I am inclined towards the higher doses and for *[[Enterococcus]]* and *S*. *aureus*. And bone levels are good. [^4] For VRE, 9 mg/kg had better outcomes. [^5] **For CrCl < 30** [^6] Skin and soft tissue: 4 mg/kg IV qod. Sndocarditis 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 and myopathy. The risk goes up with statins. [^7] 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." [^8] Better studies trump poorer studies, right? Rare: eosinophilic [[pneumonia]]. [^9]Although I have seen two cases. One case of rhabdomyolysis. [^10] ### Important drug interactions ### Rants and Screeds ### Pearls Resistance can occur on therapy, in part a cross-reaction to resistance to platelet-derived cationic proteins. This is really cool and I suggest reading the article. [^11] ### 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]], [^12] which is in my experience. [^13] Probably as septic emboli are mostly not in the alveroli. ### Class Cyclic lipopeptide. ### Puswhisperers [Once or Twice in a Career](http://www.pusware.com/PW3/OnceOrTwice.html) [Audio. The Gobbet 'o Pus Podcast](http://www.pusware.com/gobbet/gop455.mp3) [Forgetful or Atypical](http://www.pusware.com/PW4/Forgetful.html) [Audio. The Gobbet 'o Pus Podcast](http://www.pusware.com/gobbet/gop587.mp3) ### Rationalizations [^1]: Falcone M, Russo A, Venditti M, Novelli A, Pai MP. Considerations for higher doses of [[daptomycin]] in critically ill patients with methicillin-resistant [[Staphylococcus]] aureus bacteremia. Clin Infect Dis. 2013 Dec;57(11):1568-76. doi: 10.1093/cid/cit582. Epub 2013 Sep 17. PMID: 24046298. [^2]: Figueroa DA, Mangini E, Amodio-Groton M, Vardianos B, Melchert A, Fana C, Wehbeh W, Urban CM, Segal-Maurer S. Safety of high-dose intravenous [[daptomycin]] treatment: three-year cumulative experience in a clinical program. Clin Infect Dis. 2009 Jul 15;49(2):177-80. doi: 10.1086/600039. PMID: 19500039. [^3]: Bassetti M, Nicco E, Ginocchio F, Ansaldi F, de Florentiis D, Viscoli C. High-dose [[daptomycin]] in documented [[Staphylococcus]] aureus infections. Int J Antimicrob Agents. 2010 Nov;36(5):459-61. doi: 10.1016/j.ijantimicag.2010.07.011. Epub 2010 Sep 16. PMID: 20846832. [^4]: Grillon A, Argemi X, Gaudias J, Ronde-Ousteau C, Boeri C, Jenny JY, Hansmann Y, Lefebvre N, Jehl F. Bone penetration of [[daptomycin]] in diabetic patients with bacterial foot infections. Int J Infect Dis. 2019 Aug;85:127-131. doi: 10.1016/j.ijid.2019.05.011. Epub 2019 May 13. PMID: 31096056. [^5]: Britt NS, Potter EM, Patel N, Steed ME. Comparative Effectiveness and Safety of Standard-, Medium-, and High-Dose [[Daptomycin]] Strategies for the Treatment of [[Vancomycin]]-Resistant Enterococcal Bacteremia Among Veterans Affairs Patients. Clin Infect Dis. 2017 Mar 1;64(5):605-613. doi: 10.1093/cid/ciw815. PMID: 28011602. [^6]: Chaves RL, Chakraborty A, Benziger D, Tannenbaum S. Clinical and pharmacokinetic considerations for the use of [[daptomycin]] in patients with [[Staphylococcus]] aureus bacteraemia and severe renal impairment. J Antimicrob Chemother. 2014 Jan;69(1):200-10. doi: 10.1093/jac/dkt342. Epub 2013 Sep 12. PMID: 24030545. [^7]: Ryan K Dare, Chad Tewell, Bryan Harris, Patty W Wright, Sara L Van Driest, Eric Farber-Eger, George E Nelson, Thomas R Talbot, Effect of Statin Coadministration on the Risk of [[Daptomycin]]-Associated Myopathy, Clinical Infectious Diseases, Volume 67, Issue 9, 1 November 2018, Pages 1356–1363, https://doi.org/10.1093/cid/ciy287 [^8]: Bethany Lehman, Elizabeth A Neuner, Victor Heh, Carlos Isada, A Retrospective Multisite Case-Control Series of Concomitant Use of [[Daptomycin]] and Statins and the Effect on Creatine Phosphokinase, _Open Forum Infectious Diseases_, Volume 6, Issue 11, November 2019, ofz444, [https://doi.org/10.1093/ofid/ofz444](https://doi.org/10.1093/ofid/ofz444) [^9]: Lal Y, Assimacopoulos AP. Two cases of [[daptomycin]]-induced eosinophilic [[pneumonia]] and chronic pneumonitis. Clin Infect Dis. 2010 Mar 1;50(5):737-40. doi: 10.1086/650487. PMID: 20121418. [^10]: Papadopoulos S, Ball AM, Liewer SE, Martin CA, Winstead PS, Murphy BS. Rhabdomyolysis during therapy with [[daptomycin]]. Clin Infect Dis. 2006 Jun 15;42(12):e108-10. doi: 10.1086/504379. Epub 2006 May 10. PMID: 16705566. [^11]: Miller WR, Bayer AS, Arias CA. Mechanism of Action and Resistance to [[Daptomycin]] in [[Staphylococcus]] aureus and Enterococci. Cold Spring Harb Perspect Med. 2016 Nov 1;6(11):a026997. doi: 10.1101/cshperspect.a026997. PMID: 27580748; PMCID: PMC5088507. [^12]: Crass RL, Powell KL, Huang AM. [[Daptomycin]] for the treatment of [[Staphylococcus]] aureus infections complicated by septic pulmonary emboli. Diagn Microbiol Infect Dis. 2019 Feb;93(2):131-135. doi: 10.1016/j.diagmicrobio.2018.09.004. Epub 2018 Sep 14. PMID: 30279024. [^13]: https://www.azquotes.com/author/68445-Mark_Crislip