Successful Treatment of Diabetic Foot Osteomyelitis with Dalbavancin

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.