Daptomycin and eosinophilic pneumonia

Daptomycin and eosinophilic pneumonia

Eosinophilic pneumonia, characterised by an accumulation of eosinophils in lung tissue, is a known possible adverse drug reaction that can occur after use of daptomycin. Patients treated with daptomycin should be informed of the signs and symptoms of eosinophilic pneumonia so that they can seek immediate medical attention if they develop relevant symptoms.

eosinophilic pneumonia, daptomycin, antibiotics, staphylococci, antibiotic resistance

Incident data


Case: 2024

Age group: 30-60 years

Sex: male

Medicinal product: Cubicin®

Active substance: daptomycin

Indication: Empiric antibiotic therapy following revision of an implant-associated infection

ADRs: Acute eosinophilic pneumonia

Outcome: recovering

Following surgical revision of an implant-associated infection of the upper ankle joint, the patient received medication including high-dose intravenous daptomycin. Seven days after the start of antibiotic therapy, he developed a fever and a dry cough with increasing inflammatory markers. A chest CT showed bilateral, largely peripherally distributed, patchy thickening. A comprehensive microbiological workup did not detect any pathogens. Eosinophilia was found in a peripheral blood smear and bronchoalveolar lavage fluid (7% in the lavage). Treatment with daptomycin was discontinued and the patient recovered without steroid treatment.

Summary and recommendation

The most frequent symptoms of eosinophilic pneumonia are coughing, fever and shortness of breath. Most cases occur after more than two weeks of treatment. Patients with signs or symptoms of eosinophilic pneumonia must undergo a medical examination immediately, including a bronchoalveolar lavage, to rule out alternative causes of disease.

Diagnostic findings are diffuse pulmonary infiltrates and elevated eosinophil counts in lung tissue or bronchoalveolar lavage fluid. The absence of peripheral eosinophilia does not rule out diagnosis of eosinophilic pneumonia.

Daptomycin must be discontinued if signs of eosinophilic pneumonia occur. Corticosteroid treatment may also be necessary to reduce inflammation. Daptomycin must not be taken again by the patient concerned.

Particular caution is indicated when using daptomycin in order to recognise this rare but potentially severe adverse reaction at an early stage and treat it appropriately.

Statutory duty of healthcare professionals to report adverse drug reactions (ADRs)

In Switzerland, healthcare professionals who are authorised to dispense or administer medicinal products are obligated to report severe and/or previously unknown side effects. Reports to Swissmedic can be entered and sent in the Electronic Vigilance Reporting Portal “ElViS” (ElViS login).


(1) Medicinal product information for Cubicin®: Information for healthcare professionals

(2) BfArM risk information: