Question
Can daptomycin (Cubicin) treat pneumonia?
Answer
No, daptomycin cannot be used to treat pneumonia because it is inactivated by alveolar surfactant in the lung.
The cause of this is related to daptomycin’s mechanism of action which includes calcium-dependent insertion into the bacterial membrane. It has been demonstrated that daptomycin incubated in the presence of surfactant and calcium was able to be removed from solution by a simple centrifugation that also removed surfactant aggregates.
A Curious Note – Pulmonary Septic Emboli
While daptomycin cannot treat bronchoalveolar pneumonia, saying daptomycin cannot be used for any type of pulmonary infection would not be a fully true statement. It has been proposed that daptomycin can be used to treat infective endocarditis that involves pulmonary septic emboli (i.e., hematogenous pulmonary infection). The proposed reason that this may be an option is that pulmonary septic emboli are not located where surfactant is in the lung, and therefore inactivation by surfactant is not a problem.
This noted, caution is advised. Failure has been reported with daptomycin when treating infections involving pulmonary septic emboli and the topic is controversial.
A Second Curious Note – Eosinophilic Pneumonia
Daptomycin has been associated with pulmonary eosinophilia, which may cause acute eosinophilic pneumonia.
As far as I could investigate, the cause of this is unknown, but may be related to daptomycin binding to pulmonary surfactant. This may lead to epithelial injury and inflammation, which eventually leads to promoting release of eosinophil production and migration to the lungs.
Daptomycin-induced eosinophilic pneumonia is a very uncommon toxicity to encounter.
It is ironic that a drug that cannot be used to treat pneumonia can cause a type of pneumonia.
References/Readings
- Silverman JA, et al. Inhibition of daptomycin by pulmonary surfactant: in vitro modeling and clinical impact. JID. 2015.
- Harada Y, et al. In vivo efficacy of daptomycin against methicillin-resistant Staphylococcus aureus in a mouse model of hematogenous pulmonary infection. AAC. 2013
- Pertel PE, et al. Effects of prior effective therapy on the efficacy of daptomycin and ceftriaxone for the treatment of community-acquired pneumonia. Clin Infect Dis. 2008.
- Zainah H, et al. Daptomycin Failure for Treatment of Pulmonary Septic Emboli in Native Tricuspid and Mitral Valve Methicillin-Resistant Staphylococcus aureus Endocarditis. CRID. 2013.
- Hagiya H, et al. Ineffectiveness of daptomycin in the treatment of septic pulmonary emboli and persistent bacteremia caused by methicillin-resistant Staphylococcus aureus. Intern Med. 2013.
- Crass RL, et al. Daptomycin for the treatment of Staphylococcus aureus infections complicated by septic pulmonary emboli. DMID. 2019.
- Morrisette T, et al. A comparison of daptomycin alone and in combination with ceftaroline fosamil for methicillin-resistant Staphylococcus aureus bacteremia complicated by septic pulmonary emboli. EJCMID. 2020.
- Portalatin G, et al. Daptomycin-Induced Acute Eosinophilic Pneumonia. Cureus. 2021.
- Uppal P, et al. Daptomycin-induced eosinophilic pneumonia – a systematic review. ARIC. 2016.
ANSWERED BY
Timothy P. Gauthier, Pharm.D., BCPS, BCIDP – February 2024
Q&A DISCLAIMER
The ID PharmD Q&A pages attempt to answer common pharmacy questions by providing the perspective and opinion of a trained expert with knowledge relevant to the question. That noted, these answers are not provided as all-inclusive comprehensive responses. This is not provided for direct patient care purposes.
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