Q: Daptomycin is a good alternative to vancomycin if required to use in MRSA meningitis?
Daptomycin has no role in Central Nervous System (CNS) infections. It has very poor penetration into the cerebrospinal fluid (CSF). This is due to two reasons. First, it has a high molecular mass, and second, it is highly protein-bound. Unlike other drugs, meningeal inflammation does not increase its CSF penetration.
Also, it is not a good choice in pneumonia as it gets inactivated by alveolar surfactants. It has its the best value in skin and soft tissue infections with Methicillin-resistant Staphylococcus aureus (MRSA).
1. Piva S, Di Paolo A, Galeotti L, et al. Daptomycin Plasma and CSF Levels in Patients with Healthcare-Associated Meningitis. Neurocrit Care 2019; 31:116.
2. Kullar R, Chin JN, Edwards DJ, et al. Pharmacokinetics of single-dose daptomycin in patients with suspected or confirmed neurological infections. Antimicrob Agents Chemother 2011; 55:3505.
3. Silverman JA, Mortin LI, Vanpraagh AD, et al. Inhibition of daptomycin by pulmonary surfactant: in vitro modeling and clinical impact. J Infect Dis 2005; 191:2149.