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Antibiotics - Cyclic lipopeptides: Nursing Pharmacology

Notes

Notes

ANTIBIOTICS: CYCLIC LIPOPEPTIDES
DRUG NAME
daptomycin (Cubicin, Cubicin RF)
CLASS
Cyclic lipopeptide antibiotic
MECHANISM OF ACTION
Binds to and perforate bacterial membrane → rapid depolarization → DNA, RNA, and protein synthesis inhibition → bacterial cell death
INDICATIONS
  • Complicated skin infections caused by gram-negative bacteria
  • Bacteremia caused by Staphylococcus aureus
  • Infective endocarditis caused by MRSA
ROUTE(S) OF ADMINISTRATION
  • IV
  • Intrathecal
SIDE EFFECTS
  • Headache, dizziness, insomnia
  • Hypo- or hypertension
  • Abdominal pain, nausea, vomiting, diarrhea, Clostridioides difficile infection (CDI)
  • Pain or burning with urination
  • Skin rash, itching, pallor
  • Peripheral neuropathy → numbness and tingling
  • Eosinophilic pneumonia
  • Nephrotoxicity
  • Anemia
  • Rhabdomyolysis
  • Hypersensitivity reactions
CONTRAINDICATIONS AND CAUTIONS
  • Pregnancy and breastfeeding
  • Children and elderly clients
  • Eosinophilic pneumonia
  • Gastrointestinal, renal, or muscular disease
  • Combination with tobramycin, warfarin, and statins
NURSING CONSIDERATIONS for
ANTIBIOTICS: CYCLIC LIPOPEPTIDES
ASSESSMENT AND MONITORING
Assessment and monitoring: daptomycin IV
  • Assess
    • Weight
    • Vital signs
    • Wound: degree of pain, warmth, redness, swelling, type of exudate
    • Laboratory test results: CBC, liver and renal function tests, ESR, CPK, blood culture and wound culture and sensitivity results; urinalysis
  • Confirm the correct calculation of medication to be administered in mg/kg
  • Monitor
    • Development of side effects
    • Laboratory test results
    • Intake and output
    • Therapeutic response of decreased inflammation and infection
CLIENT EDUCATION
  • Purpose of medication: kill the bacteria causing their infection; decrease pain and discomfort
  • Administered once daily IV
  • Symptoms of side effects to report
    • Myopathy or rhabdomyolysis: muscle aches, pain, or weakness
    • CDI: cramping, diarrhea, bloody stool
    • Peripheral neuropathy: numbness or tingling of their extremities
    • Eosinophilic pneumonia: cough, shortness of breath
Memory Anchors and Partner Content
Transcript

Cyclic lipopeptides are a new class of antibiotics used to treat complicated infections caused by gram-positive bacteria like Staphylococcus epidermidis, Staphylococcus haemolyticus, and Staphylococcus aureus, especially the methicillin-resistant type called MRSA, as well as Streptococcus agalactiae, Streptococcus pyogenes, and Enterococcus faecalis.

It is also used in bacteremia caused by Staphylococcus aureus, and infective endocarditis caused by MRSA.

Currently, there is only one approved medication in this class, called daptomycin, which is given intravenously or intrathecally.

Once administered, it works by binding to the bacterial membrane and perforating it, creating holes that leak ions, causing rapid depolarization.

This ultimately leads to inhibition of bacterial DNA, RNA, and protein synthesis, which in turn results in bacterial cell death.

Common side effects of daptomycin include headache, dizziness, insomnia, and hypo- or hypertension.

Clients might also experience gastrointestinal side effects, such as abdominal pain, nausea, vomiting, and diarrhea.

In addition, daptomycin may disrupt the healthy intestinal flora, which can allow certain bacteria like Clostridioides difficile to survive and overgrow within the gastrointestinal tract, rarely but potentially leading to Clostridioides difficile infection or CDI for short.

Other side effects include pain or burning with urination, as well as skin manifestations like rash, itching, and pallor, while some clients may also experience numbness and tingling from peripheral neuropathy.

Other serious side effects include eosinophilic pneumonia, nephrotoxicity, anemia, myopathy and rhabdomyolysis with or without renal failure, and hypersensitivity reactions like angioedema or anaphylaxis.

Now, daptomycin should be used with caution during pregnancy and breastfeeding, as well as in children and elderly clients.

Precaution should be taken in clients with eosinophilic pneumonia, as well as in those with gastrointestinal, renal, or muscular disease.

Sources
  1. "Focus on Nursing Pharmacology" LWW (2019)
  2. "Pharmacology" Elsevier Health Sciences (2014)
  3. "Mosby's 2021 Nursing Drug Reference" Mosby (2020)