lPREGNANCYManufacturer advises use only if potential
benefit outweighs risk—no information available.
lBREAST FEEDINGPresent in milk in small amounts, but
absorption from gastrointestinal tract negligible.
lHEPATIC IMPAIRMENTManufacturer advises caution in
severe hepatic impairment—no information available.
lRENAL IMPAIRMENTManufacturer advises the dosage
regimen has not been established—use with caution and
monitor renal function regularly.
lMONITORING REQUIREMENTS
▶Manufacturer advises monitor plasma creatine
phosphokinase (CPK) before treatment and then at least
weekly during treatment; monitor CPK more frequently in
patients at higher risk of developing myopathy, including
those with renal impairment, taking other drugs
associated with myopathy, or if CPK elevated more than
5 times upper limit of normal before treatment.
▶Manufacturer advises monitor renal function regularly
during concomitant administration of potentially
nephrotoxic drugs.
lEFFECT ON LABORATORY TESTSInterference with assay for
prothrombin time and INR—take blood sample
immediately before daptomycin dose.
lDIRECTIONS FOR ADMINISTRATIONForintravenous
infusion, manufacturer advises give intermittently in
Sodium Chloride 0. 9 %; reconstitute with Sodium Chloride
0. 9 %( 350 mg in 7 mL, 500 mg in 10 mL); gently rotate vial
without shaking; allow to stand for at least 10 minutes
then rotate gently to dissolve; dilute requisite dose in
50 mL infusionfluid and give over 60 minutes for children
aged 1 – 6 years and over 30 minutes for children aged
7 – 17 years.
lHANDLING AND STORAGEManufacturer advises store in a
refrigerator ( 2 – 8 °C)—consult product literature for
further information regarding storage after reconstitution
and dilution.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Powder for solution for infusion
▶Daptomycin (Non-proprietary)
Daptomycin 350 mgDaptomycin 350 mg powder for solution for
infusion vials| 1 vialP£ 60. 00 (Hospital only)
Daptomycin 500 mgDaptomycin 500 mg powder for solution for
infusion vials| 1 vialP£ 88. 00 (Hospital only)
▶Cubicin(Merck Sharp & Dohme Ltd)
Daptomycin 350 mgCubicin 350 mg powder for concentrate for
solution for infusion vials| 1 vialP£ 62. 00
Daptomycin 500 mgCubicin 500 mg powder for concentrate for
solution for infusion vials| 1 vialP£ 88. 57 (Hospital only)Fosfomycin 22-Mar-2017
lDRUG ACTIONFosfomycin, a phosphonic acid
antibacterial, is active against a range of Gram-positive
and Gram-negative bacteria includingStaphylococcus
aureusand Enterobacteriaceae.lINDICATIONS AND DOSE
Acute uncomplicated lower urinary-tract infections (in
females)
▶BY MOUTH USING GRANULES
▶Child 12–17 years (female): 3 gfor 1 dose.Osteomyelitis when first-line treatments are
inappropriate or ineffective|Hospital-acquired lower
respiratory-tract infections when first-line treatments
are inappropriate or ineffective
▶BY INTRAVENOUS INFUSION
▶Neonate up to 40 weeks corrected gestational
age: 100 mg/kg daily in 2 divided doses.▶Neonate 40 weeks to 44 weeks corrected gestational
age: 200 mg/kg daily in 3 divided doses.▶Child 1–11 months (body-weight up to
10 kg): 200 – 300 mg/kg daily in 3 divided doses,
consider using the high-dose regimen in severe
infection, particularly when suspected or known to be
caused by less sensitive organisms
▶Child 1–11 years (body-weight 10–39 kg): 200 – 400 mg/kg
daily in 3 – 4 divided doses, consider using the high-
dose regimen in severe infection, particularly when
suspected or known to be caused by less sensitive
organisms
▶Child 12–17 years (body-weight 40 kg and above): 12 – 24 g
daily in 2 – 3 divided doses (max. per dose 8 g), use the
high-dose regimen in severe infection, particularly
when suspected or known to be caused by less sensitive
organisms
Complicated urinary-tract infections when first-line
treatment ineffective or inappropriate
▶BY INTRAVENOUS INFUSION
▶Neonate up to 40 weeks corrected gestational
age: 100 mg/kg daily in 2 divided doses.▶Neonate 40 weeks to 44 weeks corrected gestational
age: 200 mg/kg daily in 3 divided doses.▶Child 1–11 months (body-weight up to
10 kg): 200 – 300 mg/kg daily in 3 divided doses,
consider using the high-dose regimen in severe
infection, particularly when suspected or known to be
caused by less sensitive organisms
▶Child 1–11 years (body-weight 10–39 kg): 200 – 400 mg/kg
daily in 3 – 4 divided doses, consider using the high-
dose regimen in severe infection, particularly when
suspected or known to be caused by less sensitive
organisms
▶Child 12–17 years (body-weight 40 kg and above): 12 – 16 g
daily in 2 – 3 divided doses (max. per dose 8 g), use the
high-dose regimen in severe infection, particularly
when suspected or known to be caused by less sensitive
organisms
Bacterial meningitis when first-line treatment ineffective
or inappropriate
▶BY INTRAVENOUS INFUSION
▶Neonate up to 40 weeks corrected gestational
age: 100 mg/kg daily in 2 divided doses.▶Neonate 40 weeks to 44 weeks corrected gestational
age: 200 mg/kg daily in 3 divided doses.▶Child 1–11 months (body-weight up to
10 kg): 200 – 300 mg/kg daily in 3 divided doses,
consider using the high-dose regimen in severe
infection, particularly when suspected or known to be
caused by less sensitive organisms
▶Child 1–11 years (body-weight 10–39 kg): 200 – 400 mg/kg
daily in 3 – 4 divided doses, consider using the high-
dose regimen in severe infection, particularly when
suspected or known to be caused by less sensitive
organisms
▶Child 12–17 years (body-weight 40 kg and above): 16 – 24 g
daily in 3 – 4 divided doses (max. per dose 8 g), use the356 Bacterial infection BNFC 2018 – 2019
Infection5