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Dr. Grey AI

Peptide

Daptomycin (Cubicin)

Daptomycin is a cyclic lipopeptide antibiotic for serious gram-positive infections. FDA-approved 2003 (cSSSI) and 2006 (S. aureus bacteremia/endocarditis). First-in-class lipopeptide with rapid bactericidal activity against MRSA/MSSA. Phase 3: cSSSI success 83.4% vs 84.2% comparators (n=902). Bacteremia/endocarditis: 44.2% vs 41.7% standard therapy (noninferior, P met). Significantly less nephrotoxicity than vancomycin+gentamicin (11.0% vs 26.3%, P=0.004). SAFETY CONCERN: CPK elevation/myopathy (2.8%), monitor weekly; eosinophilic pneumonia (rare but serious); avoid with statins.

Research notice. This page is for education and research. Peptides may not be FDA-approved for human use and may only be legally available for research. Talk to a qualified clinician before considering any peptide.

Best evidence
Grade A
Conditions studied
2
Outcomes
12
Graded outcomes
4233

Evidence by condition

  • Strong
  • Moderate
  • Limited
  • Very limited

2 conditions, plus general outcomes

Skin and Soft Tissue Infections

Skin and Soft Tissue Infections: outcomes studied for Daptomycin (Cubicin)
GradeOutcomeEffectSizeStudiesPeopleStudies list
Clinical Cure - Skin Infections (cSSSI)

Pivotal Phase 3 trials (n=902): Clinical success 83.4% daptomycin vs 84.2% conventional therapy (noninferiority met). 4 mg/kg IV once daily for 7-14 days. Effective against MRSA (microbiologic success similar). Noninferior to vancomycin, penicillinase-resistant penicillins.

NoneNo effect24 studies

Studies that measured clinical cure - skin infections (csssi)

and 14 more in the citations list

Myopathy/CPK Elevation

SAFETY CONCERN: CPK elevation >5x ULN in 2.8% of patients (vs 1.8% comparators). Myopathy/rhabdomyolysis reported. Weekly CPK monitoring recommended. Discontinue if CPK >1000 U/L with symptoms or >2000 U/L asymptomatic. Avoid concurrent statins when possible.

Worsens (the measure goes down)Small effect18 studies

Studies that measured myopathy/cpk elevation

and 8 more in the citations list

Eosinophilic Pneumonia Risk

SAFETY CONCERN: Rare but serious eosinophilic pneumonia reported (onset typically 2-4 weeks). Presents with fever, dyspnea, diffuse infiltrates, eosinophilia. Generally reversible upon discontinuation. Also inactivated by pulmonary surfactant - contraindicated for community-acquired pneumonia.

Worsens (the measure goes up)Small effect19 studies

Studies that measured eosinophilic pneumonia risk

and 9 more in the citations list

Staphylococcal Bacteremia and Endocarditis

Staphylococcal Bacteremia and Endocarditis: outcomes studied for Daptomycin (Cubicin)
GradeOutcomeEffectSizeStudiesPeopleStudies list
Bacteremia/Endocarditis Cure

Fowler NEJM 2006 (n=246): Treatment success at 42 days 44.2% vs 41.7% standard therapy (noninferiority met). 6 mg/kg IV daily. Effective for both MRSA and MSSA right-sided endocarditis. CAMERA2 trial: Adding beta-lactam did not improve outcomes vs daptomycin alone.

NoneNo effect17 studies

Studies that measured bacteremia/endocarditis cure

and 7 more in the citations list

Nephrotoxicity vs Standard Therapy

Fowler NEJM 2006: Clinically significant renal dysfunction 11.0% daptomycin vs 26.3% standard therapy (vancomycin+gentamicin), P=0.004. Significant renal-sparing advantage. Does not require renal dose adjustment until CrCl <30 mL/min.

Improves (the measure goes down)Large effect16 studies

Studies that measured nephrotoxicity vs standard therapy

and 6 more in the citations list

General

General: outcomes studied for Daptomycin (Cubicin)
GradeOutcomeEffectSizeStudiesPeopleStudies list
Safety/Tolerability

6 human trials and systematic reviews support this finding. Evidence includes systematic reviews/meta-analyses. Human clinical trial data available.

Improves (the measure goes up)Small effect9 studies

Studies that measured safety/tolerability

Antimicrobial Activity

15 systematic reviews and preclinical studies support this finding. Evidence includes systematic reviews/meta-analyses. Primarily preclinical evidence.

Improves (the measure goes up)Moderate effect13 studies

Studies that measured antimicrobial activity

and 3 more in the citations list

Liver Protection

3 systematic reviews and preclinical studies support this finding. Evidence includes systematic reviews/meta-analyses. Primarily preclinical evidence.

Improves (the measure goes up)Small effect6 studies

Studies that measured liver protection

Kidney Function

3 human trials support this finding. Human clinical trial data available.

Improves (the measure goes up)Small effect6 studies

Studies that measured kidney function

Sepsis Outcomes

2 human trials support this finding. Human clinical trial data available.

Improves (the measure goes down)Small effect5 studies

Studies that measured sepsis outcomes

Lipid Profile

2 preclinical studies support this finding. Primarily preclinical evidence.

Improves (the measure goes down)Small effect5 studies
Pulmonary Function

2 preclinical studies support this finding. Primarily preclinical evidence.

Improves (the measure goes up)Small effect5 studies

Key findings

  • Clinical Cure - Skin Infections (cSSSI)Skin and Soft Tissue Infections
  • Myopathy/CPK ElevationSkin and Soft Tissue InfectionsWorsens (the measure goes down)
  • Bacteremia/Endocarditis CureStaphylococcal Bacteremia and Endocarditis

Safety notes in the studies

  • Avoid concurrent statins when possible.

Studies cited

41 studies from PubMed

  1. Daptomycin-induced pulmonary eosinophilia: early identification of antibiotic side effects.BMJ case reports, 2025 · PMID 40473316
  2. Daptomycin treatment for persistent bacteremia in a pediatric solid organ transplant recipient: Case report and literature review.Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy, 2025 · PMID 39216593
  3. Daptomycin Dosage Optimization in Renal Impairment Using Model-Informed Precision Dosing.Therapeutic drug monitoring, 2024 · PMID 39264343
  4. Lipidation Engineering in Daptomycin Biosynthesis.Journal of the American Chemical Society, 2024 · PMID 39465544
  5. Daptomycin-Induced Eosinophilic Pneumonia: A Case Report and Systematic Review.Chemotherapy, 2024 · PMID 37963447
  6. Daptomycin for the treatment of acute bacterial meningitis: A narrative review.International journal of antimicrobial agents, 2023 · PMID 36870402
  7. Daptomycin as an option for lock therapy: a systematic literature review.Future microbiology, 2023 · PMID 37622290
  8. Efficacy and safety of daptomycin in Japanese pediatric participants with complicated skin and soft tissue infections or bacteremia caused by gram-positive cocciJ Infect Chemother, 2022 · PMID 34920946
  9. Daptomycin synergistic properties from in vitro and in vivo studies: a systematic review.The Journal of antimicrobial chemotherapy, 2022 · PMID 36227704
  10. Effect of vancomycin or daptomycin with vs without an antistaphylococcal β-lactam on mortality, bacteremia, relapse, or treatment failure in patients with MRSA bacteremia: A randomized clinical trialJAMA, 2020 · PMID 32044943
  11. Efficacy and safety of daptomycin: systematic review and meta-analysisJ Glob Antimicrob Resist, 2020 · PMID 32082568
  12. Population pharmacokinetics of daptomycin in critically ill patients with various degrees of renal impairment.The Journal of antimicrobial chemotherapy, 2019 · PMID 30295740
  13. Daptomycin for the treatment of Staphylococcus aureus infections complicated by septic pulmonary emboli.Diagnostic microbiology and infectious disease, 2019 · PMID 30279024
  14. Daptomycin to bone and joint infections and prosthesis joint infections: a systematic review.The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases, 2019 · PMID 31207214
  15. Daptomycin for complicated skin infections: a randomized trialPediatrics, 2017 · PMID 28202770
  16. Daptomycin-Phosphatidylglycerol Domains in Lipid Membranes.Langmuir : the ACS journal of surfaces and colloids, 2017 · PMID 29130685
  17. Possible Hepatotoxicity Associated With Daptomycin: A Case Report and Literature Review.Journal of pharmacy practice, 2016 · PMID 26763341
  18. Daptomycin Pharmacokinetics and Pharmacodynamics in Septic and Critically Ill Patients.Drugs, 2016 · PMID 27412121
  19. An open-label, pragmatic, randomized controlled clinical trial to evaluate the comparative effectiveness of daptomycin versus vancomycin for the treatment of complicated skin and skin structure infectionBMC Infect Dis, 2015 · PMID 26547411
  20. Evaluation of Effectiveness and Safety of High-Dose Daptomycin: Results from Patients Included in the European Cubicin(®) Outcomes Registry and Experience.Advances in therapy, 2015 · PMID 26610384
  21. Insights and clinical perspectives of daptomycin resistance in Staphylococcus aureus: A review of the available evidence.International journal of antimicrobial agents, 2015 · PMID 26143590
  22. Daptomycin versus linezolid for treatment of vancomycin-resistant enterococcal bacteremia: systematic review and meta-analysis.BMC infectious diseases, 2014 · PMID 25495779
  23. Safety and efficacy of daptomycin as first-line treatment for complicated skin and soft tissue infections in elderly patients: an open-label, multicentre, randomized phase IIIb trialInt J Antimicrob Agents, 2013 · PMID 23990341
  24. Safety of daptomycin in patients completing more than 14 days of therapy: results from the Cubicin® Outcomes Registry and experience.International journal of antimicrobial agents, 2013 · PMID 23394685
  25. Daptomycin: a review of properties, clinical use, drug delivery and resistance.Mini reviews in medicinal chemistry, 2012 · PMID 22356191
  26. Complicated skin and soft tissue infections: literature review of evidence for and experience with daptomycinEur J Clin Microbiol Infect Dis, 2011 · PMID 21753891
  27. Effects of daptomycin in combination with other antimicrobial agents: a review of in vitro and animal model studies.The Journal of antimicrobial chemotherapy, 2009 · PMID 19825818
  28. Daptomycin-induced acute renal and hepatic toxicity without rhabdomyolysis.The Annals of pharmacotherapy, 2008 · PMID 18381844
  29. Daptomycin: a review 4 years after first approval.Pharmacology, 2008 · PMID 17940348
  30. Daptomycin: a review of its use in the management of complicated skin and soft-tissue infections and Staphylococcus aureus bacteraemiaDrugs, 2007 · PMID 17600394
  31. Daptomycin versus standard therapy for bacteremia and endocarditis caused by Staphylococcus aureusN Engl J Med, 2006 · PMID 16914701
  32. The efficacy and safety of daptomycin: first in a new class of antibiotics for Gram-positive bacteria.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 2006 · PMID 16445721
  33. Update on daptomycin: the first approved lipopeptide antibiotic.Expert opinion on pharmacotherapy, 2006 · PMID 16805723
  34. [Daptomycin, the first cydal antibiotic of a new class active against Gram positive pathogens].Le infezioni in medicina, 2006 · PMID 17380085
  35. Daptomycin: a lipopeptide antibiotic for the treatment of serious Gram-positive infections.The Journal of antimicrobial chemotherapy, 2005 · PMID 15705644
  36. Daptomycin: a novel cyclic lipopeptide antimicrobial.American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists, 2005 · PMID 15914875
  37. Antimicrobial update: Daptomycin.The Pediatric infectious disease journal, 2005 · PMID 16220092
  38. Natural products to drugs: daptomycin and related lipopeptide antibiotics.Natural product reports, 2005 · PMID 16311632
  39. The safety and efficacy of daptomycin for the treatment of complicated skin and skin-structure infectionsClin Infect Dis, 2004 · PMID 15227611
  40. Daptomycin - a novel antibiotic against Gram-positive pathogens.Expert opinion on pharmacotherapy, 2004 · PMID 15500379
  41. Daptomycin: a cyclic lipopeptide antimicrobial agent.Clinical therapeutics, 2004 · PMID 15639687