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There has been no daptomycin MIC creep in S. aureus over time, as determined using ENTRY antimicrobial data(1)

Daptomycin MIC distribution against MRSA isolates (n=8981) in the US (2002-2007)²

MIC=minimum inhibitory concentration.

*Between September 2003 and April 2005, single lots of Mueller-Hinton broth used for susceptibility testing by the SENTRY surveillance program contained suboptimal amounts of calcium, approximately 20% less than levels recommended by the Food and Drug Administration (FDA) and the Clinical and Laboratory Standards Institute (CLSI). This methodological error resulted in an increase in daptomycin MIC values of approximately one 2-fold dilution across all S. aureus subsets tested during 2004. Analysis of the SENTRY surveillance data from prior (2002-2003) and subsequent years (2005-2007) supports the hypothesis.

References:
1. Castanheira M, Jones RN, Sader HS. Update of the in vitro activity of daptomycin tested against 6710 Gram-positive cocci isolated in North America (2006). Diagn Microbiol Infect Dis. 2008; Feb 29 [Epub ahead of print].
2. Data on file. Antimicrobial Activity and Spectrum of Daptomycin: Results from the SENTRY Antimicrobial Surveillance Program 2002-2007. North Liberty, IA: JMI Laboratories.
3. Data on file. Cubist Pharmaceuticals, Inc.

Indications and Important Safety Information

CUBICIN® (daptomycin for injection) is indicated for the following infections:
- Complicated skin and skin structure infections caused by susceptible isolates of the following Gram-positive microorganisms: S. aureus (including methicillin-resistant isolates), Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus dysgalactiae subspecies equisimilis, and Enterococcus faecalis (vancomycin-susceptible isolates only). Combination therapy may be clinically indicated if the documented or presumed pathogens include Gram-negative or anaerobic organisms
- S. aureus bloodstream infections (bacteremia), including those with right-sided infective endocarditis, caused by methicillin-susceptible and methicillin-resistant isolates. Combination therapy may be clinically indicated if the documented or presumed pathogens include Gram-negative or anaerobic organisms
The efficacy of CUBICIN in patients with left-sided infective endocarditis due to S. aureus has not been demonstrated. The clinical trial of CUBICIN in patients with S. aureus bloodstream infections included limited data from patients with left-sided infective endocarditis; outcomes in these patients were poor. CUBICIN has not been studied in patients with prosthetic valve endocarditis or meningitis
Patients with persisting or relapsing S. aureus infection or poor clinical response should have repeat blood cultures. If a culture is positive for S. aureus, MIC susceptibility testing of the isolate should be performed using a standardized procedure, as well as diagnostic evaluation to rule out sequestered foci of infection. Appropriate surgical intervention (eg, debridement, removal of prosthetic devices, valve replacement surgery) and/or consideration of a change in antibiotic regimen may be required
CUBICIN is not indicated for the treatment of pneumonia
Clostridium difficile-associated diarrhea (CDAD) has been reported with the use of nearly antibacterial agents, including CUBICIN, and may range in severity from mild diarrhea to fatal colitis. CDAD has been reported to occur over 2 months post-antibiotic treatment. If CDAD is suspected, antibiotic treatment may need to be suspended
Patients receiving CUBICIN should be monitored for the development of muscle pain or weakness, particularly of the distal extremities. In patients who receive CUBICIN, creatine phosphokinase (CPK) levels should be monitored weekly, and more frequently in patients who received recent prior or concomitant therapy with an HMG-CoA reductase inhibitor. In patients with renal insufficiency, both renal function and CPK should be monitored more frequently. Patients who demonstrate unexplained elevations in CPK while receiving CUBICIN should be monitored more frequently
CUBICIN should be discontinued in patients with unexplained signs and symptoms of myopathy in conjunction with CPK elevation >1000 U/L (~5 x ULN), or in patients without reported symptoms who have marked elevations in CPK >2000 U/L (≥10 x ULN)
Most adverse events reported in CUBICIN clinical trials were mild to moderate in intensity. The most common CUBICIN adverse events were anemia, constipation, diarrhea, nausea, vomiting, injection-site reactions, and headache

Please refer to full Prescribing Information

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