Presentation & History Angela is a 47-year-old Hispanic female with a history of recurrent foot ulcers. She presents with an open wound on her left foot that developed 3 weeks ago. The patient reports pain in the area. Purulent discharge is present upon pressure to the affected area.

• Prior hospitalization 6 months ago for a similar ulcerated infection of the foot
  • Vancomycin administered in-patient
  • Discharged on oral antibiotic therapy
  • Physician reports that patient may have been noncompliant with oral therapy
• History of diabetes, depression, and hypertension
  • Medications include an oral hypoglycemic, a selective serotonin reuptake inhibitor (SSRI), and an antihypertensive
• Examination: temperature 100.7°F, pulse 90, RR 16, BP 135/80, middle-aged female
  • Lungs: clear to auscultation, bilaterally
  • Heart: S3 gallop, regular rhythm
  • HEENT: pupils reactive, no lesions
  • Extremities: decreased sensation to light touch in both feet; 1+ pitting, pretibial edema, bilaterally; dorsalis pedis pulse palpable, but weak; 3.5-cm erosive lesion on the side of the first metatarsophalangeal joint, with purulent discharge, erythema, and tenderness

A wound culture of the site showed Gram-positive cocci.

The presumptive diagnosis is MRSA complicated skin infection.

• Patient reports concern for maintaining her work and personal schedules
• Physician and patient agree home infusion therapy is an appropriate choice for managing this infection

This profile is for educational purposes only and is not based on an actual patient.
Actual diagnoses and treatments must be determined by attending physicians.

Proven clinical success of CUBICIN 4 mg/kg once daily in complicated skin infections, including MRSA and MSSA1*


CUBICIN once daily for complicated skin infections and bacteremia caused by S. aureus


CLCR = creatinine clearance; CAPD = continuous ambulatory peritoneal dialysis.

• Once daily 30-minute, 50-mL infusion
• No required monitoring of drug level in blood
• Can be given by peripheral line, midline, or peripherally inserted central catheter
• Low potential for drug-drug interactions (not metabolized via CYP450)
  • No known drug-drug interactions with SSRIs
• Permanent J-code reimbursement: J0878
  • 24-hour hotline: 1-866-RX-DAPTO

References: 1. Arbeit RD, Maki D, Tally FP, Campanaro E, Eisenstein BI. The safety and efficacy of daptomycin for Clin Infect Dis. 2004;38:1673-1681. The treatment of complicated skin and skin structure infections. 2. Silverman JA, Perlmutter NG, Shapiro HM. Correlation of daptomycin bactericidal activity and membrane depolarization in Staphylococcus aureus. Antimicrob Agents Chemother. 2003;47:2538-2544.

Presentation & History Roger is a 56-year-old African American male with renal impairment and a history of prior exposure to vancomycin. During a recent appointment, he was noted to have fever and chills, which led the clinic to transfer him to the hospital.

Examination: temperature 101°F, pulse 110, BP 100/70, middle-aged male in no apparent distress

• HEENT: pupils reactive, no oral lesions, no bruits
• Lungs: clear to auscultation, bilaterally
• Heart: S3 gallop, regular rhythm
• Extremities: no edema, peripheral pulses weak but palpable
• Neurological: nonfocal exam

Lab analyses reveal a white blood cell count of 9,000 with 80% neutrophils and 5% bands. A chest x-ray is within normal limits. Gram-positive cocci were cultured in blood.

The initial presumptive diagnosis is MRSA bacteremia (later confirmed by culture). Presumed source of infection is catheter; catheter pulled.

This profile is for educational purposes only and is not based on an actual patient.
Actual diagnoses and treatments must be determined by attending physicians.

Proven clinical success of CUBICIN 6 mg/kg once daily in S. aureus bacteremia

• In a post hoc analysis among 46 patients with S. aureus bacteremia where catheter is a source, clinical success—based solely on efficacy criteria|| — was reported in 92% of patients treated with CUBICIN vs 81% of patients treated with comparators1

CI=confidence interval.

*Patients in the comparator treatment arm were to receive vancomycin + 4 days of initial low-dose gentamicin or a semisynthetic penicillin + 4 days of initial low-dose gentamicin. (95% CI for the difference in success rates [CUBICIN – comparator]; intent-to-treat population.)

†Patients in the MRSA subgroup of the comparator treatment arm were to receive vancomycin + 4 days of initial low-dose gentamicin; however, 1 patient received a semisynthetic penicillin instead of vancomycin + 4 days of initial low-dose gentamicin. Four patients received vancomycin alone. (97.5% CI for the difference in success rates [CUBICIN – comparator; adjusted for multiplicity]; intent-to-treat population.)

‡Patients in the MSSA subgroup of the comparator treatment arm were to receive a semisynthetic penicillin + 4 days of initial low-dose gentamicin; however, 10 patients received vancomycin instead of a semisynthetic penicillin + 4 days of initial low-dose gentamicin. Three patients received semisynthetic penicillin alone. (97.5% CI for the difference in success rates [CUBICIN – comparator; adjusted for multiplicity]; intent-to-treat population.)

§ The MRSA subgroup was prespecified in the protocol.

|| Only patients with persisting/relapsing S. aureus infection, death, or clinical failure at the Test of Cure visit 6 weeks after the end of therapy were considered failures in this analysis, which differs from the definition of clinical failure in the overall study.



Significantly less renal decline (P =.004)2¶


Dual-therapy was defined as treatment with vancomycin or a semisynthetic penicillin + 4 days of initial low-dose gentamicin.

¶ Decreased renal function defined as a creatinine clearance level <50 mL/min if baseline clearance was =50 mL/min or a decrease of =10 mL/min if baseline clearance was <50 mL/min.

Dosing once every 48 hours for renally-impaired patients with complicated skin infections and S. aureus bacteremia


CLCR = creatinine clearance; CAPD = continuous ambulatory peritoneal dialysis.
#These dosing recommendations are based on pK data.

• Administer after hemodialysis on hemodialysis days
• Separate reimbursement apart from composite rate
• Patients with CLCR <30 mL/min, including those on hemodialysis and with CAPD, were excluded from CUBICIN pivotal trials

References: 1. Boucher H, Corey G, Filler S, Parsonnet J, Campion M, Fowler V. Appropriateness of two-week therapy for catheter-related (cath-rel) S. aureus bacteremia (SAB). Poster presented at: the 46th Annual ICAAC Meeting; September 27-30, 2006; San Francisco, Calif. Poster L-1204. 2. Fowler VG Jr, Boucher HW, Corey GR, et al. Daptomycin versus standard therapy for bacteremia and endocarditis caused by Staphylococcus aureus. N Engl J Med. 2006;355:653-665.

Presentation & History George is a 63-year-old, overweight white male who is recovering on the cardiac care wing of a teaching hospital following femoral popliteal bypass surgery in the right leg. Past medical history includes poorly controlled diabetes, hypertension, and a 2-pack-a-day smoking habit for the past 35 years.

It is significant that this hospital has noted an increased incidence of MRSA infections in postsurgical patients over the past 2 years.

Examination: temperature 100.8°F, pulse 98, RR 16, BP 145/90, a middle-aged male in no acute distress

• Lungs: clear to auscultation, bilaterally
• Extremities: popliteal pulse is good, on left side pulse is double; surgical site appears erythematous; no discharge is observed
• Medications include antihypertensives and hypoglycemics

The patient has a white blood cell count of 12,000 with 85% neutrophils and 5% bands. His BUN/creatinine is 23/1.3.

A wound culture of the surgical site showed Gram-positive cocci.

The initial diagnosis is complicated skin infection at the surgical site with presumptive MRSA (later confirmed by culture).

This profile is for educational purposes only and is not based on an actual patient.
Actual diagnoses and treatments must be determined by attending physicians.

Proven clinical success of CUBICIN 4 mg/kg once daily in complicated skin infections, including MRSA and MSSA1*


CUBICIN once daily for complicated skin infections and bacteremia caused by S. aureus


CLCR = creatinine clearance; CAPD = continuous ambulatory peritoneal dialysis.

• Once daily 30-minute, 50-mL infusion
• No required monitoring of drug level in blood
• Low potential for drug-drug interactions (not metabolized via CYP450)

Reference: 1. Arbeit RD, Maki D, Tally FP, Campanaro E, Eisenstein BI. The safety and efficacy of daptomycin for the treatment of complicated skin and skin structure infections. Clin Infect Dis. 2004;38:1673-1681.

Presentation & History Helen is a 71-year-old obese, diabetic white female with a chief complaint of extreme pain near her right ankle over the past 2 weeks. She has noted an ulcer at the site, accompanied by radiating pain and swelling. She has covered the site with sterile bandages.

Past medical history is significant for varicose vein surgery 3 years ago in the area of her right leg below the knee and above the ankle. Medications include hypoglycemics to manage her diabetes.

With the onset of pain, she self-medicated with aspirin and daily leg elevation.

Examination: temperature 100.6°F, pulse 92, RR 16, BP 110/68, obese female in no acute distress

• Lungs: clear to auscultation, bilaterally
• Heart: no murmurs, rubs, or gallops
• Abdomen: soft, nontender
• Extremities: limbs cool to touch, abnormal pedal pulses; ulcer has clearly demarcated border with exposure of ankle tendon, pitting edema, and venous dermatitis

Transcutaneous oxygen measurement confirms poor arterial flow to the right leg.

The initial diagnosis is a stasis ulcer with infection presumptively due to MRSA.

This patient was initially started on vancomycin; however, at 48 hours no improvement was seen upon visual inspection of the infection site.

This profile is for educational purposes only and is not based on an actual patient.
Actual diagnoses and treatments must be determined by attending physicians.

Proven clinical success of CUBICIN 4 mg/kg once daily in complicated skin infections, including MRSA and MSSA1†


CUBICIN once daily for complicated skin infections and bacteremia caused by S. aureus


CLCR = creatinine clearance; CAPD = continuous ambulatory peritoneal dialysis.

• Once daily 30-minute, 50-mL infusion
• No required monitoring of drug level in blood
• Low potential for drug-drug interactions (not metabolized via CYP450)
  • No known drug-drug interactions with selective serotonin reuptake inhibitors

Reference: 1. Arbeit RD, Maki D, Tally FP, Campanaro E, Eisenstein BI. The safety and efficacy of daptomycin for the treatment of complicated skin and skin structure infections. Clin Infect Dis. 2004;38:1673-1681.