Daptomycin

INTRODUCTION

Indications

Complicated skin and skin structure infections caused by aerobic gram-positive bacteria.

Action

Causes rapid depolarization of membrane potential following binding to bacterial membrane; this results in inhibition of protein, DNA, and RNA synthesis. Therapeutic Effects: Death of bacteria with resolution of infection. Spectrum: Active against Staphylococcus aureus (including methicillin-resistant strains), Streptococcus pyogenes, S. agalactiae, some S. dysgalactiae, and Enterococcus faecalis (vancomycin-susceptible strains).

Adverse Reactions/Side Effects

CNS: dizziness. Resp: dyspnea. CV: hypertension, hypotension. GI: PSEUDOMEMBRANOUS COLITIS, constipation, diarrhea, nausea, vomiting, ↑ liver function tests. GU: renal failure. Derm: pruritus, rash. Hemat: anemia. Local: injection site reactions. MS: ↑ CPK. Misc: fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of pseudomembranous colitis, including diarrhea, abdominal pain, fever, pus or mucus in stools, and other severe or prolonged GI problems (nausea, vomiting, heartburn). Notify physician or nursing staff immediately of these signs.

• Monitor signs of renal failure, including decreased urine output, increased blood pressure (BP), muscle cramps/twitching, edema/weight gain from fluid retention, yellowish brown skin, and confusion that progresses to seizures and coma. Report these signs to the physician immediately.

• Assess BP and compare to normal values (See Appendix F). Report changes in BP, either a problematic decrease in BP (hypotension) or a sustained increase in BP (hypertension).

• Monitor signs of anemia, including unusual fatigue, shortness of breath with exertion, and bruising. Notify physician immediately if these signs occur.

• Assess any breathing problems, and report signs of difficult of labored breathing.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

• Monitor IV injection site for pain, swelling, and irritation. Report prolonged or excessive injection site reactions to the physician.

Interventions

• Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection. Employ universal precautions or isolation procedures as indicated for specific patients.

Patient/Client-Related Instruction

• Instruct patient to notify physician immediately of signs of superinfection, including black, furry overgrowth on tongue, vaginal itching or discharge, and loose or foul-smelling stools.

• Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged fever, skin problems (rash, itching), or GI problems (nausea, vomiting, diarrhea, constipation).

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.

Distribution: Unknown.

Protein Binding: 92%.

Metabolism and Excretion: Metabolism not known; mostly ...