Table 1.

Daptomycin summary information

Structure	Cyclic lipopeptide
Mechanism of action	Bactericidal, binds cytoplasmic membrane, with resultant depolarization of membrane potential, cellularion effl ux and cell death
In vitro activity	Gram positive organisms, including MRSA, VRSA, and vancomycin resistant enterococci
CSLI susceptibility cutoff	≤1 μg/ml; supplementation to 50 μg/ml Ca2+ required for testing in Muellar-Hinton broth
Pharmacokinetics	Given intravenously, (half- life 8 hours, volume of distribution 100 ml/kg, protein biding 90%-93%, Cmax94 μg/ml with 6 mg/kg dose at steady state, linear kinetics through 12 mg/kg
Excretion	78% renal
Pharmacodynamics	Concentration dependent killing, post-antibiotic effect of 6 hours against S. aureus
US FDA approved indications	Treatment of complicated skin and skin structure infections (caused by susceptible strains of Gram-positive microorgansisms, including MSSA and MRSA); S. aureus bacteremia, including those with right-sided endocarditis, caused by MSSA and MRSA
FDA approved dose	4 mg/kg q24h for skin and soft tissue infections; 6 mg/kg q24h for bacteremia and endocarditis
Dose for renal dysfunction	Creatinine clearance ≤30 ml/min: 4 mg/kg q48h for skin and soft tissue infections; 6 mg/kg q48h for bacteremia and endocarditis; for hemodialyis, dose after hemodialysis
Adverse reactions	CPK elevation with and without myopathy, transient neuropathy
Drug interactions	HMG-CoA inhibitors
Cost	$171 for 500 mg
Pregnancy	Class B

Abbreviations: CSLI, Clinical and Laboratory Standards Institute; CPK, creative phosphokinase; FDA, Food and Drug Administration; MRSA, methicillin-resistant S.aureus; MSSA, methicillin-sensitive S.aureus; VRSA, vancomycin-resistant S.aureus