Clinical Medicine Insights: Therapeutics

Daptomycin is an antibacterial agent with activity against Gram-positive organisms and is a reliable option for the treatment of invasive Gram-positive infections. Daptomycin has been approved for the treatment of complicated skin and skin-structure infections and bacteremia including right-sided endocarditis. In methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and endocarditis, it has been shown to be noninferior to conventional treatment with vancomycin with or without an aminoglycoside. It has also been used successfully in the treatment of soft-tissue infections. Little experience is available on the treatment of bone and joint infections, although initial data are encouraging. Daptomycin has rapid bactericidal activity that is associated with its unique mechanism of action on the cell membrane. It has favorable pharmacokinetic properties allowing once-daily dosing. Toxicity is rare with currently recommended dosing. With the rising antimicrobial resistance in Gram-positive infections, the use of daptomycin is expected to increase in the following years. However, as a consequence of its increased use, daptomycin resistance may emerge as a significant problem. The current data suggest that daptomycin has a relevant role in the therapeutic armamentarium of physicians for the treatment of Gram-positive infections.