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.

daptomycin

a miscellaneous antiinfective.
indications This drug is used to treat complicated skin and skin structure infections caused by Staphylococcus aureus (including methicillin-resistant strains), S. agalactiae, S. dysgalactiae, and Enterococcus faecalis (vancomycin-susceptible strains only).
contraindication Known hypersensitivity to this drug prohibits its use.
adverse effects Adverse effects of this drug include hypotension, hypertension, increased creatinine phosphokinase, nausea, constipation, diarrhea, vomiting, dyspepsia, headache, insomnia, dizziness, muscle pain or weakness, arthralgia, fungal infection, urinary tract infection, anemia, nephrotoxicity, rash, and pruritus. A life-threatening side effect is pseudomembranous colitis.
References in periodicals archive ?
Malacidin appears to work differently than daptomycin, which was introduced in 2003 and has yet to be challenged by resistant bacteria.
Therefore, the aim of this study was to determine in vitro susceptibility to vancomycin, daptomycin, linezolid and tedizolid of MRSA clinical isolates from patients with skin and soft tissue infections, collected in three tertiary-care hospitals of Medellin, Colombia.
A total of 389 cSSSI patients were included in the study, with 257 receiving daptomycin and 132 receiving standard-of-care (SOC) treatment (mostly vancomycin or clindamycin).
Daptomycin "may be particularly suitable" as an alternative to vancomycin for treating MRSA, "because the higher vancomycin doses recommended for treating methicillin-resistant pathogens can cause deteriorating renal function while the patient is on therapy," they noted.
As of July 2016, Daptomycin for injection had annual sales of approximately USD1.
We retrospectively determined the minimum inhibitory concentration (MIC) of daptomycin for clinically relevant, non-repetitive 30 MRSA and 20 methicillin-sensitive Staphylococcus aureus (MSSA) isolates randomly selected from 1615 Staphylococcus aureus isolates obtained from pus and wound swab samples (n=6687) submitted to the microbiology laboratory for aerobic culture and sensitivity profiling during January 2011 to December 2011.
I feel very comfortable using adjusted-dose daptomycin for patients with VRE bacteremia, especially in those with uncomplicated bacteremia," lead investigator Jerod Nagel, Pharm.
The superbug appears to be building resistance to one of the few antibiotics that works against it - daptomycin.
Very few existing studies evaluate daptomycin for the treatment of urinary tract infections (UTIs)," study investigator Hannah R.
By comparison, in a newly completed phase III study of daptomycin, success rates were in the upper 80% range, said Uwe Trostmann, Ph.
Safety and Clinical Outcomes of Daptomycin at Doses of 10 mg/kg (Presentation 779) Friday, October 19, 2012, 12:30 p.