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Daptomycin Eosinophilic Pneumonia — SCE Infectious Diseases MCQ

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HardAntimicrobial StewardshipDaptomycin Eosinophilic PneumoniaSCE Infectious Diseases

A 60-year-old man with MRSA bacteraemia is treated with IV Daptomycin. He develops a cough. CXR shows new bilateral pulmonary infiltrates. He has peripheral eosinophilia (2.8 × 10⁹/L). What complication should be considered?

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Correct answer: D — Daptomycin-induced eosinophilic pneumonia — Daptomycin is inactivated by pulmonary surfactant and must NEVER be used for pneumonia; paradoxically, it can CAUSE eosinophilic pneumonia as an adverse effect

Daptomycin-induced eosinophilic pneumonia is a well-described adverse effect presenting with cough, dyspnoea, fever, peripheral eosinophilia, and bilateral pulmonary infiltrates. It typically occurs after 2–4 weeks of therapy. Daptomycin is INACTIVATED by pulmonary surfactant — this is why it must never be used to TREAT pneumonia. However, it can paradoxically CAUSE pulmonary disease through an eosinophilic hypersensitivity mechanism. Management: stop Daptomycin immediately, switch to an alternative (Vancomycin, Linezolid), and administer corticosteroids for severe cases. The condition is usually reversible on drug cessation.

Reference: BNF 2024 – Daptomycin; FDA 2024 – Daptomycin safety; BSAC 2023