Demetrios Voyatzoglou Diabetic Foot Clinic, Amalia Fleming General Hospital, Athens, Greece.
Med Arch. 2020 Jun;74(3):243-245. doi: 10.5455/medarh.2020.74.243-245.
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.
We present a case of successful treatment of diabetic foot (DF) OM.
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 toe and 1 metatarsal OM (plain x-ray findings). A multi-drug resistant 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.
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.
达巴万星是一种新型抗生素，用于治疗多种耐药革兰氏阳性（+）细菌感染。达巴万星的半衰期极长。目前的适应证是皮肤和软组织感染（ABSSSI），但研究人员已成功将其超适应证用于骨髓炎（OM）患者的治疗。
我们报告了一例糖尿病足（DF）OM 成功治疗的案例。
一名 53 岁男性因新诊断的糖尿病就诊，血糖控制极差（HbA1c=12.5%），合并有糖尿病神经病变，但无外周血管病变。两个月前，他因热水烫伤足部导致左足溃疡，随后发生 ABSSSI 和 1 趾和 1 跖骨 OM（普通 X 线片发现）。在培养物中分离出一种多药耐药菌，并给予替加环素和达托霉素的靶向治疗。患者出院时还接受了 1.5 g 达巴万星治疗。2 周后，他继续在家接受利奈唑胺和替加环素治疗。我们向希腊国家卫生保健组织（EOPYY）提交了一份完整的病历、患者知情同意书和相关文献，请求超适应证使用另 1.5 g 达巴万星。在此期间，他接受了静脉注射替加环素治疗，并在家继续接受利奈唑胺治疗。他最终接受了第二剂 1.5 g 达巴万星。患者总共接受了 14 周的靶向治疗，大部分是在院外完成的。当他完成治疗时，足部状况良好，X 线片明显改善。
由于达巴万星的半衰期极长，对于由多重耐药革兰氏阳性球菌引起的 OM，它可能成为首选药物，以避免住院治疗，尤其是对不依从的患者。需要进一步的研究。
