Daptomycin is inactivated by pulmonary surfactant, so it does not work for pneumonia even when the organism is susceptible. This matters most in a patient on daptomycin for bacteraemia who develops a new chest infection, or in septic emboli to the lung where a second agent may be needed.
Daptomycin can also cause eosinophilic pneumonia, which presents as new fever, breathlessness and infiltrates, usually after the first two weeks of treatment. It resolves when the drug is stopped.
- Choose another agent for any pneumonia, even if the organism is daptomycin susceptible
- Consider eosinophilic pneumonia in a patient on daptomycin with new fever and infiltrates
- Check creatine kinase weekly, more often with statins or high doses
- Ask about muscle pain or weakness at each review
Why it matters
A susceptible result on the report can mislead when the infection is in the lung.
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