Antibiotics - Cyclic Lipopeptides: Nursing Pharmacology

Overview

• Cyclic lipopeptides: A new class of antibiotics.
• Primarily used against gram-positive bacteria.
• Effective for complicated infections and certain bacteremias.
• Notable drug: Daptomycin (Cubicin, Cubicin RF).

Daptomycin

Drug Classification

• Class: Cyclic lipopeptide antibiotic.

Mechanism of Action

• Binds to bacterial membranes.
• Perforates membranes leading to ion leakage and depolarization.
• Inhibits DNA, RNA, and protein synthesis.
• Causes bacterial cell death.

Indications

• Complicated skin infections by gram-negative bacteria.
• Bacteremia caused by Staphylococcus aureus.
• Infective endocarditis caused by MRSA.

Administration Routes

• Intravenous (IV).
• Intrathecal.

Side Effects

• Common: Headache, dizziness, insomnia, hypo/hypertension.
• Gastrointestinal: Abdominal pain, nausea, vomiting, diarrhea, potential for Clostridioides difficile infection (CDI).
• Urinary: Pain or burning sensation.
• Skin: Rash, itching, pallor.
• Neurological: Peripheral neuropathy.
• Serious: Eosinophilic pneumonia, nephrotoxicity, anemia, rhabdomyolysis, hypersensitivity reactions.

Contraindications and Cautions

• Avoid in pregnancy and breastfeeding.
• Exercise caution in children, elderly, and clients with:
  • Eosinophilic pneumonia.
  • Gastrointestinal, renal, or muscular diseases.
• Drug interactions: Tobramycin, warfarin, and statins.

Nursing Considerations

Assessment and Monitoring

• Assess:
  • Weight, vital signs.
  • Wound conditions: pain, warmth, redness, swelling.
  • Lab tests: CBC, liver/renal function, ESR, CPK, cultures.
• Monitor:
  • Side effects.
  • Laboratory results and therapeutic response.
  • Intake and output.

Client Education

• Purpose: Medication's role in reducing infection and relieving symptoms.
• Administration: Once daily via IV.
• Report side effects like myopathy, CDI, peripheral neuropathy, eosinophilic pneumonia.

Contributors

• Author: Stefan Stoisavljevic, MD
• Illustrator: Robyn Hughes, MScBMC
• Content Reviewers: Antonella Melani, MD; Lisa Miklush, PhD, RNC, CNS; Gabrielle Proper, RN, BScN, MN

Sources

• Textbooks on nursing pharmacology and drug reference guides.

These notes summarize the key aspects of cyclic lipopeptides and offer a focused guide on the nursing considerations and pharmacological aspects of daptomycin.