Cyclic Lipopeptide
TREATMENT
Daptomycin (4 mg/kg IV q24h for skin and skin structure infections; 6-12 mg/kg IV q24h for bloodstream infections) is the only FDA-approved cyclic lipopeptide. The drug exhibits rapid bactericidal activity against a wide variety of gram-positive bacteria, including enterococci, staphylococci, and streptococci.
Daptomycin is FDA-approved for treatment of skin/soft tissue infections as well as S. aureus bacteremia and right-sided endocarditis. The drug should not be used to treat lung infections as activity is decreased in the presence of pulmonary surfactant. Nonsusceptibility to daptomycin can develop during treatment, making it imperative that susceptibility of isolates be verified.SPECIAL CONSIDERATIONS
Adverse events include gastrointestinal disturbances, injection site reactions, elevated LFTs, and eosinophilic pneumonitis. Serum creatine phosphokinase (CK) should be monitored at baseline and weekly because daptomycin has been associated with skeletal muscle effects, including rhabdomyolysis. Patients should also be monitored for signs of muscle weakness and pain, and the drug should be discontinued if these symptoms develop in conjunction with marked CK elevations (5-10 times the upper limit of normal with symptoms or 10 times the upper limit of normal without symptoms). Concomitant use of statins should be avoided, if possible, because of the potential increased risk of myopathy.