Daptomycin: pharmacology and clinical use.

IMPORTANCE OF THE FIELD: Infections caused by Gram-positive organisms have increased in frequency and severity. Daptomycin offers a therapeutic option in an era of increasing resistance. AREAS COVERED IN THIS REVIEW: Literature from 1986 to present was reviewed for pharmacological, preclinical and clinical studies on daptomycin. WHAT THE READER WILL GAIN: The pharmacological properties, resistance mechanisms and clinical applications of daptomycin are discussed. Recommendations are offered on the use of this agent for the treatment of resistant Gram-positive infections. TAKE HOME MESSAGE: Daptomycin is a reliable agent for the treatment of Gram-positive infections. It has been shown to be effective in bacteremia and endocarditis, as well as in soft-tissue infections caused by Gram-positive organisms. Its role in the treatment of bone and joint infections is not well-defined. Resistance is currently uncommon in clinical isolates. However, emergence of resistance during therapy is a concern. This may be prevented by use of higher doses.