DAPTOmycin


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Related to DAPTOmycin: vancomycin

DAPTOmycin

(dap-to-mye-sin) ,

Cubicin

(trade name)

Classification

Therapeutic: anti infectives
Pharmacologic: cyclic lipopeptide antibacterial agents
Pregnancy Category: B

Indications

Complicated skin and skin structure infections caused by aerobic Gram-positive bacteria.

Action

Causes rapid depolarization of membrane potential following binding to bacterial membrane; this results in inhibition of protein, DNA, and RNA synthesis.

Therapeutic effects

Death of bacteria with resolution of infection.
Active against Staphylococcus aureus (including methicillin-resistant strains), Streptococcus pyogenes, S. pyogenes agalactiae, some S. dysgalactiae, and Enterococcus faecalis (vancomycin-susceptible strains).

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.
Distribution: Unknown.
Protein Binding: 92%.
Metabolism and Excretion: Metabolism not known; mostly excreted by kidneys.
Half-life: 8.1 hr.

Time/action profile

ROUTEONSETPEAKDURATION
IVrapidend of infusion24 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity.
Use Cautiously in: CCr <30 mL/min (dose ↓ required);Moderate-to-severe renal impairment (may have ↓ clinical response); Geriatric: May have ↓ clinical response with ↑ risk of adverse reactions; Obstetric: Use only if clearly needed; Lactation: Lactation; Pediatric: Safety not established.

Adverse Reactions/Side Effects

Central nervous system

  • dizziness

Respiratory

  • eosinophilic pneumonia (life-threatening)
  • dyspnea

Cardiovascular

  • hypertension
  • hypotension

Gastrointestinal

  • pseudomembranous colitis (life-threatening)
  • constipation
  • diarrhea
  • nausea
  • vomiting
  • ↑ liver enzymes

Genitourinary

  • renal failure

Dermatologic

  • pruritus
  • rash

Hematologic

  • anemia

Local

  • injection site reactions

Musculoskeletal

  • ↑ CPK

Miscellaneous

  • fever

Interactions

Drug-Drug interaction

Tobramycin ↑ blood levels.Concurrent HMG-CoA reductase inhibitors may ↑ the risk of myopathy.

Route/Dosage

Intravenous (Adults) 4 mg/kg every 24 hr.

Renal Impairment

Intravenous (Adults) CCr <30 mL/min—4 mg/kg every 48 hr.

Availability

Powder for injection: 500 mg/vial

Nursing implications

Nursing assessment

  • Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy.
  • Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis. May begin up to several weeks following cessation of therapy.
  • Monitor for signs and symptoms of eosinophilic pneumonia (new onset or worsening fever, dyspnea, difficulty breathing, new infiltrates on chest imaging studies). Discontinue daptomycin if symptoms occur.
  • Monitor for development of muscle pain or weakness, particularly of distal extremities. Discontinue daptomycin in patients with unexplained signs and symptoms of myopathy in conjunction with CPK elevation >1000 U/L, or in patients without reported symptoms who have marked elevations in CPK >2000 U/L. Consider temporarily suspending agents associated with rhabdomyolysis (HMG-CoA reductase inhibitors) in patients receiving daptomycin.
  • Lab Test Considerations: Monitor CPK weekly, more frequently in patients with unexplained ↑. Discontinue daptomycin if CPK >1000 units/L and signs and symptoms of myopathy occur. In patients with renal insufficiency, monitor both renal function and CPK more frequently.
    • May cause false prolongation of PT and ↑ INR.

Potential Nursing Diagnoses

Risk for infection (Indications,  Side Effects)

Implementation

  • Do not confuse daptomycin with dactinomycin.
  • Intravenous Administration
  • pH: 4.5.
  • Reconstitute 500-mg vial with 10 mL of 0.9% NaCl inserted toward wall of vial. Rotate vial gently to wet powder. Allow to stand for 10 min undisturbed. Swirl vial gently to completely reconstitute solution. Reconstituted vials are stable for 12 hr at room temperature or 48 hr if refrigerated. Concentration: 50 mg/mL.
  • Rate: Administer over 2 min.
  • Intermittent Infusion: Diluent: Dilute further in 50 mL of 0.9% NaCl. Solution is stable for 12 hr at room temperature or 48 hr if refrigerated. Do not administer solutions that are cloudy or contain a precipitate.
  • Rate: Infuse over 30 min. Do not infuse daptomycin with ReadyMED® elastomeric infusion pumps due to incompatibility.
  • Y-Site Compatibility: alfentanil, amifostine, amikacin, aminophylline, aminocaproic acid, amiodarone, amphotericin B liposome, ampicillin, ampicillin/sulbactam, argatroban, arsenic trioxide, atracurium, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, busulfan, butorphanol, calcium chloride, calcium gluconate, carboplatin, carmustine, caspofungin, cefazolin, cefepime, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol, chlorpromazine, ciprofloxacin, cisatracurium, cisplatin, clindamycin, cyclophosphamide, cyclosporine, dacarbazine, dactinomycin, daunorubicin hydrochloride, dexamethasone sodium phosphate, dexmedetomidine, dexrazoxane, diazepam, digoxin, diltiazem, diphenhydramine, dobutamine, docetaxel, dolasetron, dopamine, doripenem, doxacurium, doxorubicin hydrochloride, doxorubicin liposome, doxycycline, droperidol, enalaprilat, epinephrine, epirubicin, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentanyl, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furosemide, ganciclovir, gentamicin, glycopyrrolate, granisetron, haloperidol, heparin, hydralazine, hydrocortisone sodium succinate, hydromorphone, idarubicin, ifosfamide, insulin, irinotecan, isoproterenol, ketorolac, labetalol, leucovorin, levofloxacin, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, meropenem, mesna, metaraminol, methyldopate, methylprednisolone sodium succinate, metoclopramide, metoprolol, midazolam, milrinone, mitoxantrone, morphine, moxifloxacin, mycophenolate mofetil, nafcillin, nalbuphine, naloxone, nicardipine, nitroprusside, norepinephrine, octreotide, ondansetron, oxaliplatin, oxytocin, paclitaxel, palonosetron, pamidronate, pancuronium, pemetrexed, pentamidine, phenobarbital, phentolamine, phenylephrine, piperacillin/tazobactam, potassium acetate, potassium chloride, potassium phosphates, procainamide, prochlorperazine, promethazine, propranolol, quinupristin/dalfopristin, ranitidine, rocuronium, sodium acetate, sodium bicarbonate, sodium phosphates, succinylcholine, tacrolimus, teniposide, theophylline, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, topotecan, trimethoprim/sulfamethoxazole, vasopressin, vecuronium, verapamil, vinblastine, vincristine, vinorelbine, voriconazole, zidovudine, zoledronic acid
  • Y-Site Incompatibility: acyclovir, alemtuzumab, allopurinol, amphotericin B colloidal, amphotericin B lipid complex, cytarabine, dantrolene, gemcitabine, imipenem/cilastatin, methotrexate, metronidazole, mitomycin, nesiritide, nitroglycerin, pantoprazole, pentazocine, pentobarbital, phenytoin, remifentanil, streptozocin, sufentanil, thiopental, vancomycin
  • Solution Incompatibility: D5W

Patient/Family Teaching

  • Inform patient of purpose of medication.
  • Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional.
  • May cause dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
  • Advise patient to notify health care professional immediately if signs and symptoms of eosinophilic pneumonia occur.

Evaluation/Desired Outcomes

  • Resolution of the signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.
References in periodicals archive ?
When evaluating the ICU survival time, we found that patients treated with polymyxin B, carbapenems, or daptomycin after positive culture had significantly longer survival time.
The most frequently prescribed antibiotics did not change between initial line and final line treatment, with vancomycin IV (initial 58%, final 53%), clindamycin IV (initial 20%, final 14%), and daptomycin IV (initial 7%, final 9%) used most frequently.
Additional agents with activity against coagulase-negative staphylococci and MRSA include daptomycin, tedizolid, telavancin, dalba-vancin, oritavancin, ceftaroline, and quinupristin-dalfopristin.
(Also, "mal" means bad in Latin, and "cide" means to kill.) It is a distant relative of daptomycin, a powerful antibiotic that uses calcium to disrupt bacterial cell walls.
In this mouse model, the antimicrobial effect of tocotrienol ad ministered with daptomycin potentiated the natural killer cytotoxicity and elevated wound repair markers.
When vancomycin is no longer effective in chemotherapy, particularly for MRSA infections, a membrane-active antibiotic like daptomycin is employed as the next course of action.
Daptomycin, linezolid, and vancomycin are commonly used antibiotics for these indications (daptomycin is indicated for ABSSSI but not indicated for nosocomial pneumonia); however, increased selective pressure to these antibiotics has resulted in outbreaks of bacterial resistance to these antibiotics.
Alternative drugs for bloodstream infections caused by MRSA have been released, including telavancin, dalbavancin, oritavancin, and daptomycin; however, these options are not affordable in some developing countries [11].
* High MICs for Vancomycin and Daptomycin and Complicated Catheter- Related Bloodstream Infections with Methicillin- Sensitive Staphylococcus aureus