CUBICIN Data Tour
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IDSA=Infectious Diseases Society of America.

INDICATIONS AND IMPORTANT SAFETY INFORMATION

Indications: CUBICIN® (daptomycin) is indicated for the treatment of complicated skin and skin structure infections (cSSSI) caused by susceptible isolates of the following Gram-positive bacteria: Staphylococcus aureus (including methicillin-resistant isolates), Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus dysgalactiae subspecies equisimilis, and Enterococcus faecalis (vancomycin-susceptible isolates only); and S. aureus bloodstream infections (bacteremia), including patients with right-sided infective endocarditis.

Limitations of Use: CUBICIN is not indicated for the treatment of left-sided infective endocarditis (LIE) due to S. aureus. CUBICIN has not been studied in patients with prosthetic valve endocarditis. CUBICIN is not indicated for the treatment of pneumonia.

Warnings and Precautions

  • Anaphylaxis/hypersensitivity reactions, which may be life-threatening, have been reported with CUBICIN use. If an allergic reaction occurs, discontinue CUBICIN and treat appropriately.
  • Myopathy and rhabdomyolysis have been reported with CUBICIN use. Monitor for muscle pain or weakness, particularly
 of the distal extremities. Monitor creatine phosphokinase (CPK) levels weekly and more frequently in patients with CPK elevations while on CUBICIN treatment and in those who received recent prior or concomitant HMG-CoA reductase inhibitors. In patients with renal impairment, monitor renal function and CPK levels more than once weekly. Discontinue CUBICIN in patients with unexplained signs and symptoms of myopathy with CPK levels >1,000 U/L (~5× ULN), and in patients without symptoms and CPK levels >2,000 U/L (≥10× ULN). In addition, consider temporarily suspending agents associated with rhabdomyolysis, such as HMG-CoA reductase inhibitors.
  • Eosinophilic pneumonia has been reported with CUBICIN use. Promptly evaluate patients who develop fever, dyspnea with hypoxic respiratory insufficiency, and diffuse pulmonary infiltrates and discontinue CUBICIN immediately. Treatment with systemic steroids is recommended. Recurrence of eosinophilic pneumonia upon re-exposure has been reported.
  • Peripheral neuropathy has been reported with CUBICIN use. Monitor for signs and symptoms of peripheral neuropathy.
  • Potential nervous and/or muscular system effects in patients younger than 12 months: Avoid use of CUBICIN in patients younger than 12 months due to the risk of potential effects on muscular, neuromuscular, and/or nervous systems (either peripheral and/or central) observed in neonatal dogs.
  • Clostridium difficile–associated diarrhea (CDAD), ranging from mild diarrhea to fatal colitis, has been reported with nearly all systemic antibacterial agents, including CUBICIN. Careful medical history is necessary because CDAD has been reported to occur more than two months after the administration of antibacterial agents. If CDAD is suspected or confirmed, antibacterial use not directed against C. difficile should be discontinued, if possible.
  • Patients with persisting or relapsing S. aureus bacteremia/endocarditis, possibly due to reduced daptomycin susceptibility, or poor clinical response should have repeat blood cultures. Appropriate surgical intervention and/or change in antibacterial regimen may be required. Failure of treatment due to persisting or relapsing S. aureus bacteremia/endocarditis may be due to reduced daptomycin susceptibility.
  • In the cSSSI and S. aureus bacteremia/endocarditis trials, decreased efficacy was observed in CUBICIN-treated patients with moderate baseline renal impairment (CrCL <50 mL/min).

Adverse Reactions: The most clinically significant adverse reactions observed with CUBICIN 4 mg/kg (cSSSI trials) and 6 mg/kg (S. aureus bacteremia/endocarditis trial) were abnormal liver function tests, elevated CPK, and dyspnea.

Please see full Prescribing Information.

  • Strength of recommendation “A” defined as good evidence to support recommendation for or against use
  • Quality of evidence “I” defined as evidence from ≥1 properly randomized, controlled trials
  • Quality of evidence “II” defined as evidence from well-designed, controlled studies without randomization

References:

  1. Fowler VG Jr, Boucher HW, Corey GR, et al; S. aureus Endocarditis and Bacteremia Study Group. Daptomycin versus standard therapy for bacteremia and endocarditis caused by Staphylococcus aureus. N Engl J Med. 2006;355(7):653-665.
  2. CUBICIN Prescribing Information, Cubist Pharmaceuticals; Lexington, MA.
  3. Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011;52(3):e18-e55.
  4. Arbeit RD, Maki D, Tally FP, et al: Daptomycin 98-01 and 99-­01 Investigators. The safety and efficacy of daptomycin for the treatment of complicated skin and skin-­structure infections. Clin Infect Dis. 2004;38(12):1673-­1681.
  5. Data on file, Cubist Pharmaceuticals; Lexington, MA.
  6. Rege S, Mohr J, Lamp KC, et al. Safety of daptomycin in patients completing more than 14 days of therapy: results from the Cubicin® Outcomes Registry and Experience. Int J Antimicrob Agents. 2013;41(5):421-425.
  7. Shrestha NK, Mason P, Gordon SM, et al. Adverse events, healthcare interventions and healthcare utilization during home infusion therapy with daptomycin and vancomycin: a propensity score-matched cohort study. J Antimicrob Chemother. 2014;69(5):1407-1415.