Daptomycin is inactivated by pulmonary surfactant, so it is not suitable for treating pneumonia, though it is used for bacteraemia and skin and soft-tissue infections. It can cause myopathy, so creatine kinase should be checked at baseline and at least weekly during treatment.
Review concurrent statins, and stop daptomycin if there are unexplained muscle symptoms with a raised creatine kinase.
- Do not use daptomycin for pneumonia.
- Check creatine kinase at baseline and at least weekly.
- Review whether a statin is needed during the course.
- Ask about muscle pain or weakness at each review.
- Adjust the dose for renal function.
Why it matters
Both the lung exclusion and the muscle toxicity are easy to overlook when the antibiotic was chosen for bacteraemia.
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