Daptomycin is inactivated by pulmonary surfactant, so it does not treat pneumonia, including MRSA pneumonia, even though it is active against the organism. It is used for Staphylococcus aureus bacteraemia, right-sided endocarditis and complicated skin and soft tissue infection.
It can cause myopathy and rhabdomyolysis. Creatine kinase should be checked at baseline and at least weekly, more often in renal impairment or with statins, which are often paused during treatment. Eosinophilic pneumonia is a rare but recognised adverse effect.
- Do not use daptomycin for pneumonia; surfactant inactivates it.
- Check creatine kinase at baseline and at least weekly during treatment.
- Consider pausing statins during daptomycin therapy.
- Adjust dosing interval in severe renal impairment.
- Think of eosinophilic pneumonia if new infiltrates and hypoxia appear on treatment.
Why it matters
Daptomycin's activity against MRSA tempts its use in every MRSA infection, but the lung is the exception.
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