Indications: complicated skin and soft-tissue infections caused by Gram-positive bacteria. Staphylococcal endocarditis.

Cautions: interference with assay for prothrombin time and INR (take blood sample immediately before daptomycin dose).

Muscle effects: Myalgia, muscle weakness, and myositis may occur uncommonly; rhabdomyolysis is very rare. Monitor creatine kinase before treatment and then weekly during treatment (more frequently if creatine kinase elevated more than 5 times upper limit of normal before treatment, or if receiving another drug known to cause myopathy (preferably avoid concomitant use), or if eGFR less than 80 ml/minute/1.73 m2). If unexplained muscle pain, tenderness, weakness, or cramps develop during treatment, measure creatine kinase every 2 days; discontinue if unexplained muscular symptoms and creatine kinase elevated markedly.

Contra-indications: Hypersensitivity

Hepatic impairment: Manufacturer advises caution in severe hepatic impairment—no information available.

Renal impairment: monitor renal function if eGFR less than 80 ml/minute/1.73 m2; use normal dose every 48 hours if eGFR less than 30 ml/minute/1.73m2.

Pregnancy: Manufacturer advises use only if potential benefit outweighs risk no information available.

Breast-feeding: Present in milk in small amounts, but absorption from gastro- intestinal tract negligible> Side Effects: nausea, vomiting, abdominal pain, flatulence, diarrhoea (antibiotic-associated colitis reported), constipation, hypertension, hypotension, headache, anxiety, insomnia, dizziness, asthenia, anemia, arthralgia, rash, pruritus, injection-site reactions.

less commonly: dyspepsia, anorexia, taste disturbance, glossitis, flushing, arrhythmias, tremor, paraesthesia, hyperglycemia, renal failure, eosinophilia, thrombocythaemia, electrolyte disturbances, muscle effects, rarely: jaundice; also reported syncope, wheezing, eosinophilic pneumonia, peripheral neuropathy Dose: By slow intravenous injection over 2 minutes or by intravenous infusion: complicated skin and soft-tissue infections caused by Gram-positive bacteria.

ADULT over 18 years: 4 mg/kg once daily; increased to 6 mg/kg once daily if associated with Staphylococcus aureus bacteremia. Staphylococcal endocarditis: adult over 18 years, : 6 mg/kg once daily.