From the Guidelines
Daptomycin is a recommended alternative to vancomycin if a patient develops pruritus, with a typical adult dose of 6 mg/kg intravenously once daily, as stated in the guidelines by the Infectious Diseases Society of America 1. When switching from vancomycin to daptomycin:
- Stop vancomycin immediately
- Start daptomycin as soon as possible
- Monitor creatine phosphokinase (CPK) levels weekly Daptomycin is effective against many gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA) 1. It works by disrupting bacterial cell membranes, leading to rapid cell death. Unlike vancomycin, daptomycin is not associated with "Red Man Syndrome" or histamine-mediated itching. Other alternatives may include linezolid or teicoplanin, depending on the specific infection and local antibiotic resistance patterns. However, daptomycin is often preferred due to its broad spectrum of activity and once-daily dosing 1. Some key points to consider when using daptomycin include:
- It is contraindicated in the treatment of S aureus pneumonia acquired via the aspiration route 1
- Higher doses of daptomycin (8-10 mg/kg) may be recommended for complicated infections, including left-sided IE, although this is not FDA-approved 1
- Daptomycin may be a reasonable alternative to vancomycin for left-sided NVE caused by MRSA, based on limited data from prospective and observational studies 1
From the FDA Drug Label
Treatment discontinuations due to adverse events occurred in 8% (72/929) of patients treated with VIBATIV, the most common events being nausea and rash (
1% each). Treatment discontinuations due to adverse events occurred in 6% (53/938) of vancomycin-treated patients, the most common events being rash and pruritus (1% each)
The alternative to vancomycin used if a patient develops pruritus is telavancin (VIBATIV) 2.
From the Research
Alternative to Vancomycin
If a patient develops pruritus, an alternative to vancomycin may be considered.
- Daptomycin is used as an alternative antibiotic in some cases, as seen in a patient who developed anaphylaxis with disseminated intravascular coagulation despite prior repeated exposure to vancomycin 3.
- Other alternatives may include linezolid, teicoplanin, or quinupristin/dalfopristin, although these are not explicitly mentioned in the provided studies.
- In some cases, vancomycin may be replaced with other antibiotics such as clindamycin, as seen in a patient with a history of chronic osteomyelitis of the right tibia 4.
Management of Vancomycin Hypersensitivity Reactions
When a patient develops a hypersensitivity reaction to vancomycin, such as vancomycin flushing syndrome (VFS) or anaphylaxis, management involves: