Trade Names:Cubicin- Powder for injection, lyophilized 500 mg
Binds to bacterial membranes and causes a rapid depolarization of membrane potential, which inhibits protein, DNA, and RNA synthesis, resulting in bacterial cell death.
At a dose of 4 mg/kg, steady-state concentrations are achieved by the third daily dose. The mean steady-state trough concentration (days 4 to 8) is 5.9 mcg/mL.
Vd at steady state is approximately 0.1 L/kg. The mean serum protein binding is approximately 92% following a dose of 4 mg/kg.
Primarily excreted by the kidney (78%).
Dosage adjustment is needed in patients with severe renal function impairment (Ccr less than 30 mL/min).
Treatment of complicated skin and skin structure infections caused by susceptible strains of gram-positive microorganisms; treatment of Staphylococcus aureus bloodstream infections, including those with right-sided infective endocarditis caused by methicillin-susceptible and methicillin-resistant isolates.
Standard considerations.
IV 4 mg/kg/day administered over a 30-min infusion every 24 h for 7 to 14 days.
S. Aureus Bloodstream InfectionAdultsIV 6 mg/kg over a 30-min infusion every 24 h for 2 to 6 wk.
Renal Function ImpairmentAdultsIV For patients with Ccr less than 30 mL/min, including those on hemodialysis or continuous ambulatory peritoneal dialysis, administer 4 mg/kg for complicated skin and skin structure infections or 6 mg/kg for S. aureus bloodstream infections once every 48 h.
Store vials in refrigerator (36° to 46°F). Reconstituted solution is stable for 12 h at room temperature (68° to 77°F) or up to 48 h if stored under refrigeration. The diluted solution is stable for 12 h at room temperature or up to 48 h if stored under refrigeration. The combined time (reconstituted vial and infusion bag) at room temperature should not exceed 12 h; the combined time (reconstituted vial and infusion bag) under refrigeration should not exceed 48 h.
If possible, consider temporarily discontinuing HMG-CoA reductase inhibitors, which have been known to cause rhabdomyolysis, until therapy has been completed.
TobramycinC max and AUC of daptomycin increased 12.7% and 8.7%, respectively, when administered with tobramycin.
None well documented.
Hypertension (6%); hypotension (5%); cardiac failure (1% to 2%).
Insomnia (9%); headache (7%); dizziness (6%); anxiety, asthenia (5%); confusion (1% to 2%).
Rash (7%); pruritus (6%); erythema, increased sweating (5%).
Pharyngolaryngeal pain (8%); sore throat (1% to 2%).
Diarrhea, vomiting (12%); constipation (11%); nausea (10%); abdominal pain (6%); dyspepsia, loose stools (4%); GI hemorrhage (2%).
Decreased renal function (11%); UTI (7%); acute renal failure, renal failure (3%); vaginal candidiasis (2%).
Anemia (13%); eosinophilia (2%).
Abnormal LFTs (3%).
Elevated CPK (9%); increased blood phosphorus (3%); increased INR ratio (2%).
Injection-site erythema (3%).
Hypokalemia (9%); edema (7%); hyperkalemia (5%); hyperglycemia, hypoglycemia (1% to 2%).
Pain in extremity (9%); back pain (7%); osteomyelitis (6%); arthralgia (3%); limb pain (2%); rhabdomyolysis (postmarketing).
Pleural effusion (6%); cough, dyspnea, pneumonia (3%).
Chest pain, peripheral edema, pyrexia (7%); injection-site reactions (6%); bacteremia, sepsis (5%); fungal infections (3%); back pain, Candida infections, cellulitis, decreased appetite (1% to 2%); anaphylaxis, hypersensitivity reactions (including difficulty swallowing, hives, pruritus, shortness of breath, truncal erythema) (postmarketing).
Category B .
Undetermined.
Safety and efficacy not established.
Dosage adjustment is needed in patients with severe renal function impairment (Ccr less than 30 mL/min).
May result in bacterial or fungal overgrowth of nonsusceptible microorganisms.
Discontinue daptomycin in patients with unexplained signs and symptoms of myopathy in conjunction with CPK elevation of more than 1,000 units/L (approximately 5 × ULN), or in patients without reported symptoms who have marked elevations in CPK of more than 2,000 units/L (at least 10 × ULN).
Perform repeat blood cultures. If culture is positive for S. aureus , perform minimum inhibitory concentration susceptibility testing of the isolate, as well as diagnostic evaluation. Consider appropriate surgical intervention and changes in the antibiotic regimen.
Consider the possibility in patients who develop diarrhea.
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