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.