CUBICIN is the trade name for Daptomycin, a lipopeptide antibacterial agent marketed by Cubist Pharmaceuticals. The chemical name of Daptomycin is N-decanoyl-L-tryptophyl-L-asparaginyl-L-aspartyl-L-threonylglycyl-L-ornithyl-L-aspartyl-D-alanyl-L-aspartylglycyl-D-seryl-threo-3-methyl-L-glutamyl-3-anthraniloyl-L-alanine[egr]1-lactone.
CUBICIN is indicated in the treatment of Vancomycin-resistant enterococcus (VRE) infection and fatal gram positive infections caused by MRSA (methicillin-resistant Staphylococcus aureus) and MSSA (Methicillin-sensitive Staphylococcus aureus). Daptomycin disrupts multiple bacterial cell membrane functions of gram positive organisms by binding to it, which causes rapid depolarization. This leads to loss of membrane potential, which in turn inhibits protein, DNA and RNA synthesis, hence causing bacterial cell death.
CUBICIN is administered only once daily at a dose of 4mg/kg for the treatment of complicated skin, skin structure (cSSSI) and soft tissue infections. These infections are often caused by susceptible strains of the Gram-positive microorganisms such as: Staphylococcus aureus (including MRSA), Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus dysgalactiae subsp. equisimilis, and Enterococcus faecalis (vancomycin-susceptible isolates only).
CUBICIN can also be dosed at 6 mg/kg for the treatment of S. aureus bloodstream infections (bacteremia), including right-sided infective endocarditis (native valve) caused by MRSA and MSSA bacteremia. CUBICIN has not been studied for the treatment of prosthetic valve infections. Proponents of CUBICIN for treating invasive S. aureus infections argue it does not worsen renal dysfunction or is less nephrotoxic in nature compared to Vancomycin.
However, CUBICIN is not approved for the treatment of left-sided infective endocarditis caused by S. aureus. The efficacy of CUBICIN has been shown to diminish in the presence of renal impairment (creatinine clearance 30-50ml/min). The frequency of side effects such as myopathy and rhabidomyolysis are increased in patients with renal impairment. CUBICIN is excreted by filtration through the kidneys.
Daptomycin molecules are inactivated in vitro by pulmonary surfactants; hence the CUBICIN is not indicated for the treatment of pneumonia. It may cause patients suffering from pneumonia to develop eosinophilic pneumonia.
Common adverse effects include muscle ache or muscle weakness known as myopathy, rhabidomyolysis, diarrhea, and peripheral neuropathy have been reported with the use of Cubicin. Patients receiving CUBICIN should be monitored closely for signs and symptoms of myopathy which maybe manifested as elevated creatine phosphokinase (CPK). Patients receiving CUBICIN may have abnormal laboratory values in relation to phosphorus level and international normalized ratio (INR) values.
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