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Daptomycin is a cyclic lipopeptide antibiotic derived from the organism Streptomyces roseosporus used to treat various bacterial infections caused by gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). Daptomycin is administered for various FDA-approved and off-label clinical uses. This educational activity for healthcare professionals reviews the mechanism of action, adverse event profile, toxicity, dosing, pharmacodynamics, and monitoring of daptomycin, providing critical knowledge for interprofessional team members treating conditions where daptomycin is appropriate. Objectives: Identify the mechanism of action of daptomycin. Assess the FDA-approved and off-label uses of daptomycin. Evaluate the adverse reactions associated with daptomycin therapy. Implement effective collaboration among interprofessional team members to improve outcomes and treatment efficacy for patients who might benefit from daptomycin therapy. Access free multiple choice questions on this topic.

Signs and Symptoms of Overdose Renal impairment affects daptomycin pharmacokinetics, with mild impairment causing a moderate reduction in clearance. Moderate/severe impairment leads to a decrease in clearance and an increase in the area under the concentration-time curve (AUC). Consequently, overdosing in these populations can lead to significantly elevated systemic drug levels, increasing the risk of adverse effects and toxicity. Patients who overdose on daptomycin may experience myalgia and rhabdomyolysis and have elevated creatine phosphokinase and potassium levels.[41][42] Management of Overdose Supportive care is recommended with the maintenance of glomerular filtration in case of overdose suspected or confirmed with daptomycin. Approximately 15% of daptomycin is cleared slowly from the body by hemodialysis (low-flux membrane) over 4 hours. High-flux dialysis membrane hemodialysis may increase the percentage of dose removal.[43] Approximately 11% of daptomycin is cleared by peritoneal dialysis over 48 hours.

Healthcare professionals, such as intensivists, infectious disease specialists, internists, and nurse practitioners who prescribe daptomycin, should monitor the patient to ensure safe medication administration. Baseline renal function tests are recommended to assess renal impairment and the necessity of dosage adjustments. Additionally, clinicians are advised to obtain weekly CPK levels in patients requiring treatment for more than 1 week. More frequent monitoring of CPK is necessary for patients with current or prior statin therapy, an unexplained elevation in CPK, or renal impairment. A board-certified infectious disease pharmacist can provide antibiogram data, verify dosing, and work with the nursing staff regarding administration. Nurses can also monitor for adverse events and administer the drug, alerting the attending promptly regarding any concerns. Patients should also be monitored by nursing staff and clinicians for muscle pain or weakness, new-onset or worsening peripheral neuropathy, and signs or symptoms of eosinophilic pneumonia. Furthermore, prescribers should order testing for C difficile infection when patients develop diarrhea. A prospective quasi-experimental study showed that a pharmacist-led antibiotic stewardship program significantly reduced antimicrobial use and costs, including daptomycin, especially in the absence of an infectious diseases physician consult service. This highlights pharmacists' crucial role in optimizing antimicrobial use and improving practices where ID support is unavailable.[44] An interprofessional team approach and communication among clinicians, infectious disease specialists, pharmacists, and specialty-trained nurses are crucial to decreasing potential adverse effects, improving disease course and quality of life, and improving patient outcomes related to daptomycin therapy.