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  • A 55-year-old man presents to the emergency department with altered mental status. The patient is brought in by his wife, who said that he had a skin infection approximately 1 week ago and did not seek treatment.  He developed fever, chills, and rigors. His temperature is 102°F (38.9°C), blood pressure is 85/65 mmHg, pulse is 115/min, and respirations at 22/min. Physical examination is notable for erythema, edema, and tenderness to palpation in the right lower calf. Blood cultures are obtained and he is started on intravenous normal saline and empiric antibiotics. Blood cultures return positive for Enteroccocus faecalis that is resistant to vancomycin and ampicillin. He is started on daptomycin. Vancomycin-resistant E. faecalis bacteremia)
  • Mechanism of action
    • binds to cell membrane, resulting in cellular depolarization
      • impairs DNA, RNA, and protein synthesis
  • Clinical use
    • S. aureus skin infection (especially MRSA)
    • S. aureus bacteremia
    • vancomycin-resistant enterococci
    • endocarditis
  • Adverse effects
    • myopathy
    • rhabdomyolysis
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