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Daptomycin in vitro susceptibility testing of Gram-positive microorganisms may be conducted via the following methods:

Etest® strips;
Broth microdilution panels (frozen or lyophilized format); and
Automated microdilution testing systems.

Daptomycin breakpoints are published in the latest issue of the CLSI (NCCLS) M100 S17 document titled Performance Standards for Antimicrobial Susceptibility Testing.

Manual Minimum Inhibitory Concentration (MIC) Susceptibility Testing Methods

Etest® Strips *

AB Biodisk North America (Catalog # DPC). FDA cleared for Gram-positive organisms. AB Biodisk is now selling DPC strips in 30- and 100-strip packs.	800-874-8814
Remel no longer sells Etest strips in the United States.

Microdilution — Lyophilized broth panels *

JustOne® Strips (12 well strip) — Trek Diagnostic Systems (Catalog # JODAP). FDA cleared for Gram-positive organisms.

800-871-8909

Microdilution — Frozen broth panels * (Daptomycin available as custom orders only)

Trek Diagnostic Systems	800-871-8909
Dade-Behring	800-242-3233
PML Microbiologicals	800-628-7014

Automated MIC Susceptibility Testing Systems *

Sensititre® — Trek Diagnostic Systems	800-871-8909
Daptomycin is available as a custom order on the Gram-positive and anaerobe plates. FDA cleared for Gram-positive organisms. Daptomycin is currently available on the GPN3F and GPN4F standard plates for non-fastidious Gram-positive organisms (the GPN plate that did not contain daptomycin has been discontinued). Daptomycin is currently available on the STP5F plate (the STP3F plate that did not contain daptomycin will be phased out by the end of 2007).
Phoenix™ — BD Diagnostic Systems	800-638-8663
FDA cleared for non-fastidious Gram-positive organisms. Daptomycin is currently available on three standard panels: PMIC-102 (Catalog # 448414), PMIC/ID-102 (Catalog # 448602), and PMIC/ID-104 (Catalog # 448604).
VITEK® 1 — bioMérieux	800-682-2666
FDA cleared for non-fastidious Gram-positive organisms. Daptomycin is currently available on the GPS-114 card (Catalog # V4655).
VITEK® 2 and VITEK® 2 Compact — bioMérieux	800-682-2666
The estimated timing for daptomycin availability on the VITEK 2 system is approximately June 2009.
MicroScan® — Dade Behring	800-241-0420
FDA cleared for non-fastidious Gram-positive organisms. Daptomycin is currently available on four standard panels: Pos Combo 25 (Catalog # B1017-204), Pos Combo 26 (Catalog # B1017-205), Pos Breakpoint Combo 23 (Catalog # B1017-206), and Pos MIC 23 (Catalog # B1017-207). Pos Breakpoint Combo 24 (Catalog # B1017-208) has been discontinued due to lack of customer demand.
Pasco™ System — BD Diagnostic Systems	800-638-8663
BD Diagnostic Systems has discontinued the Pasco system.

* All MIC systems (manual and automated) are pre-optimized for calcium content.
Daptomycin Kirby-Bauer Susceptibility Disks

Daptomycin 30µg susceptibility disks are no longer available. Laboratories should discontinue using daptomycin 30 µg disks due to the unreliable detection of isolates with a non-susceptible daptomycin MIC value, as determined by the Centers for Disease Control and Prevention (CDC), the Clinical Microbiology Institute, and Cubist's Clinical Microbiology Department (reference: Jevitt, et al. 2006. J Clin Microbiol 44:3098).

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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