Parenteral Manual

DAPTOmycin

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
CUBICIN RF
Classification: 
Antibiotic, miscellaneous
Original Date: 
September 2016
Revised Date: 
July 2020
Indications: 
  • Treatment of susceptible strains of gram positive organisms - generally restricted to treatment of severe infections where there is vancomycin resistance or intolerance, including endocarditis, methicillin-resistant Staph. aureus (MRSA) bacteremia, osteomyelitis or septic arthritis
  • Not indicated for the treatment of pneumonia.
Reconstitution and Stability: 
  • Available as 500 mg lyophilized powder per vial.
  • Reconstitute with 10 mL sterile water for injection to make a 50 mg/mL solution.  Rotate or swirl the vial for a few minutes to dissolve the contents. 
  • Reconstituted vial stable for 6 hours.
  • Stable in a minibag for up to 24 hours in the refrigerator.
Compatibility: 

- Solutions compatible:  0.9% NaCl

- Y-site compatility:  (if mixed with 0.9% NaCl) -  aztreonam, ceftazidime, ceftriaxone, dopamine, fluconazole, gentamicin, heparin, levofloxacin, lidocaine.

- Incompatible:  dextrose solutions

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct

NO

 

IV Intermittent Infusion

YES

Doses < 250 mg: Dilute to 5 mg/mL of 0.9%NaCl

Doses > 250 mg: Further dilute in 50 mL 0.9%NaCl
Infusion time:  60 minutes

IV Continuous Infusion NO

 

Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric:

Bacteremia due to susceptible S aureus or vancomycin resistant gram positive infections:

  • Age 1 - 6 years: 12 mg/kg/dose q 24 hours
  • Age 7 - 11 years: 9 mg/kg/dose q 24 hours
  • Age 12 - 17 years: 7 mg/kg/dose q24 hours

 

Complicated skin and skin structure infections:

  • Age 1 - < 2 years: 10 mg/kg/dose q 24 hours
  • Age 2 - 6 years: 9 mg/kg/dose q 24 hours
  • Age 7 - 11 years: 7 mg/kg/dose q 24 hours
  • Age 12 - 17 years: 5 mg/kg/dose q 24 hours

 

Adult:

  • 4 - 10 mg/kg/dose Q24H
Potential hazards of parenteral administration: 
  • Immediate (within 1-2 days of receiving drug):
    - Hypersensitivity or anaphylaxis; nausea, vomiting, diarrhea
  • Prompt (within 1-3 weeks):
    - Myopathy, increase creatine phosphokinase (CPK), rhabdomyolysis (increased risk with renal dysfunction); peripheral neuropathy; C. difficile associated diarrhea, eosinophilic pneumonia, anemia
Notes: 
  • Infectious diseases service consult required prior to use
  • Monitor CPK at baseline and once weekly while on therapy.
  • May cause false prolongation of PT & false increase in INR due to potential reaction with some of the reagents. Draw PT or INR just prior to next dose of DAPTOmycin to try to minimize effect.
  • Do not use for pneumonia as daptomycin is inactivated by pulmonary surfactants
References: 
  • Cubicin Product Monograph, accessed October 2019
  • Lexi-comp online – accessed March 2018

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