Safety and Efficacy Study of Daptomycin Compared to Active Comparator in Pediatric Participants With Acute Hematogenous Osteomyelitis (AHO) (MK-3009-006)

Acute hematogenous osteomyelitis is a common problem in the pediatric population, affecting
approximately 5/10,000 children each year and accounting for approximately 1% of all
pediatric hospitalizations. In children, osteomyelitis arises from bacteremic seeding of the
bone metaphysis.

Daptomycin, is a cyclic lipopeptide antibacterial active against most clinically significant
gram-positive pathogens including drug-resistant strains such as Methicillin Resistant
Staphylococcus (S.) aureus (MRSA) and Methicillin Susceptible S. aureus (MSSA). Daptomycin
has proven clinical efficacy in adults in the treatment of complicated skin and skin
structure infections (cSSSI) caused by aerobic gram-positive pathogens and the treatment of
S. aureus bloodstream infections (bacteremia; SAB), including those complicated by
right-sided infective endocarditis, caused by MSSA and MRSA. Although not indicated for
osteomyelitis, daptomycin has been successfully used to treat osteoarticular infections in
adults and children as salvage therapy and at medical centers with increasingly high rates
of vancomycin resistant organisms.

In addition, more comparative clinical trials are needed in pediatric AHO to better
elucidate the optimal treatment regimen and clinical response.

Inclusion Criteria:

- Obtain Informed Consent;

- Be 1 year to < 18 years old; a stepwise approach will be implemented to gate
enrollment as follows: enrollment will begin with children aged 2-17 years; after an
external Drug Safety Monitoring Board (DSMB) review, enrollment will be broadened to
1-17 years.

- Have diagnosis of suspected or confirmed AHO warranting IV antibacterial therapy as
inpatient, based on clinical, imaging and/or microbiological evidence as outlined
below:

I. Clinical evidence of fever accompanied by symptoms on the affected limb that include
but it is not limited to pain, tenderness on palpation, inflammation, warmth, swelling,
difficulty bearing weight, motion restriction, loss of function

II. Radiologic imaging (magnetic resonance imaging [MRI], bone scan, x-ray, or computed
tomography [CT] scan) consistent with osteomyelitis OR Microbiological evidence (gram
stain, culture or polymerase chain reaction (PCR)) from a bone biopsy or bone aspirate (if
available), or blood

III. Laboratory evidence: C-reactive protein (CRP) elevated, Erythrocyte sedimentation
rate (ESR) elevated, leukocytosis or leukopenia, immature neutrophils

•Confirmed (I, II, and III) OR suspected (I and III) that must be confirmed
post-randomization

Participants will not be allowed into the study if they:

- Have documented history of any hypersensitivity or allergic reaction to daptomycin

- Have septic arthritis only (without AHO)

- Have acute hematogenous osteomyelitis that is located in the spine

- Have chronic osteomyelitis (i.e. symptoms of osteomyelitis > 21 days) or
osteomyelitis with complications requiring non-routine surgical treatment (i.e.
sequestration).

- Have major trauma, penetrating trauma (including a puncture wound of the foot),
postoperative osteomyelitis, foreign body in or adjacent to affected bone or joint,
or other iatrogenic bone or joint infections present at the site of infection

- Have acute hematogenous osteomyelitis due to a proven gram-negative organism

- Have transient tenosynovitis, juvenile rheumatoid arthritis (JRA), reactive
arthritis, bony tumors, and other osteoarticular diseases suspected to be due to a
nonbacterial (eg, fungal or mycobacterial) etiology

- Receive more than 24 hours of effective intravenous antibacterial therapy for
osteomyelitis within 96 hours before randomization unless microbiological or clinical
failure is documented

- Require any potentially effective concomitant systemic antibacterial therapy for
gram-positive infections

- Have history of seizures (except febrile seizure of childhood)

- Have peripheral neuropathy

- Have history of rhabdomyolysis (with the exception of muscle injury due to trauma)

- Have Sickle cell anemia

- Cannot be assessed clinically during the study

- Have any condition (eg, cystic fibrosis, current septic shock) that would make the
subject, in the opinion of the Investigator, unsuitable for the study

- Have significant reduced creatinine clearance (CrCl) < 50 mL/min/1.73 m2

- Have evidence of significant hepatic, hematologic, or immunologic dysfunction

- Have Creatine kinase (CK) elevation ≥ 10 × ULN (upper limit of normal) without
symptoms or ≥ 5 × ULN with symptoms

- If female, must not be pregnant or nursing and if required by age and life style take
appropriate measures to not get pregnant during the study.

- Have participated in any study involving administration of an investigational agent
or device or daptomycin within 30 days

- Are unable or unwilling to adhere to the study-specified procedures and restrictions

- Has suspected or confirmed pneumonia, empyema, meningitis, or endocarditis.