Successful Treatment of Diabetic Foot Osteomyelitis with Dalbavancin

Abstract

Introduction: Dalbavancin is a new antibiotic against multi-drug resistant Gram (+) bacteria. Dalbavancin has an extremely long half-life. Current indication is skin and soft tissue infections (ABSSSI), but researchers have successfully administered it off-label to osteomyelitis (OM) patients.

Aim: We present a case of successful treatment of diabetic foot (DF) OM.

Case report: A 53-year-old male presented to our DF clinic, with recently diagnosed diabetes mellitus, with very bad glycaemic control (HbA1c=12,5%). He had diabetic neuropathy, but no peripheral arteriopathy. Two months before, because of an accident with hot water, he presented left foot ulcer, followed by ABSSSI and 1^st toe and 1^st metatarsal OM (plain x-ray findings). A multi-drug resistant Enterococcus faecium was isolated in cultures and a targeted treatment with tigecycline and daptomycin was administered. The patient also received 1,5 gr dalbavancin upon discharge. 2 weeks later, he continued treatment at home with linezolid and tedizolid. A complete medical record with patient's history, informed consent and relative literature was sent to Greek National Health Care Organization (EOPYY), requesting administering off-label another 1,5 gr dalbavancin. In the meanwhile, he was admitted for iv tigecyclin, and continued treatment with linezolid at home. He finally received a second dose of 1,5 g dalbavancin. Patient received totally 14 weeks' targeted therapy, mostly off-hospital. When he completed treatment, foot was in excellent condition and x-ray had significantly improved.

Conclusion: Dalbavancin, due to its extremely long half-life, could potentially be the drug of choice for OM caused by multi-drug resistant Gram (+) cocci, in order to avoid hospitalization, especially on non-complient patients. Further research is necessary.

Keywords: Dalbavancin; acute bacterial skin and skin structure infections (ABSSSI); antibacterial agents; antibiotics; diabetic foot; lipoglycopeptides; osteomyelitis.

Figures 1 and 2.. Patient with soft tissue infection (acute bacterial skin and skin structure infection, ABSSSI), and 1st toe and 1st metatarsal osteomyelitis (OM). a: before, and b: after treatment with dalbavancin.