Daptomycin Classification
Daptomycin is classified as a cyclic lipopeptide antibiotic, the first member of this novel class of antibacterial agents. 1, 2
Pharmacological Classification Details
- Daptomycin is the first intravenous cyclic lipopeptide antibiotic discovered in the early 1980s from the fermentation of Streptomyces roseosporus 3
- It represents a distinct class of antibiotics with a unique mechanism of action that differs from other antibiotic classes 2
- Daptomycin binds to bacterial cell membranes and causes rapid depolarization of membrane potential, inhibiting DNA, RNA, and protein synthesis, which results in bacterial cell death 1
FDA Approval and Clinical Applications
- Approved by the U.S. FDA in 2003 for the treatment of complicated skin and skin structure infections 3, 2
- Also approved for the treatment of Staphylococcus aureus bloodstream infections (bacteremia), including right-sided infective endocarditis 1, 4
- Demonstrates activity against a wide variety of Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci 2, 5
Key Characteristics
- Exhibits rapid, concentration-dependent bactericidal activity against Gram-positive bacteria 1, 6
- Has no cross-resistance with any other class of antibiotics, making it valuable for multi-drug resistant infections 2
- Features a relatively prolonged concentration-dependent postantibiotic effect in vitro 2
- Not indicated for pneumonia due to inactivation by pulmonary surfactant 7, 8
Clinical Considerations
- Typically administered as a once-daily intravenous infusion 4, 9
- Requires monitoring of creatine phosphokinase (CPK) levels due to potential musculoskeletal effects, particularly at higher doses (≥6 mg/kg/day) 7
- Weekly CPK monitoring is recommended for all patients, with more frequent monitoring for those with renal insufficiency or on concurrent statin therapy 7
- Resistance is uncommon but has been reported in Staphylococcus aureus, Enterococcus faecium, and Enterococcus faecalis, particularly in the context of prolonged treatment courses 5
Daptomycin's unique mechanism of action and effectiveness against resistant Gram-positive pathogens make it an important addition to the antimicrobial armamentarium, particularly for serious infections caused by drug-resistant organisms 9.