Dapto in MRSA CNS infections

 Q: Daptomycin is a good alternative to vancomycin if required to use in MRSA meningitis?

A) True

B) False

Answer: B

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).

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References:

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.