Antibiotics - Cyclic lipopeptides: Nursing pharmacology

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.