Endocrine Abstracts

Dalbavancin is a Lipoglycopeptide antimicrobial that, when administered through intravenous infusion on day 1 and day 8, maintains therapeutic concentrations within the cortical bone for up to 8 weeks; Dalbavancin is thus an option in Diabetic Foot Osteomyelitis (DFO). Here we present an 86-year-old female who attended the Diabetic Foot Protection Service at Regional Hospital Mullingar with active ulcers of her left foot, at the lateral border of her metatarsophalangeal joint (4.5cm x 5cm), hallux interphalangeal joint (1.5cm x 1.5cm) and second digit interphalangeal joint (2cm x 2cm). Past medical history was significant Type 2 Diabetes Mellitus and Chronic Kidney Disease stage 3b. Inflammatory markers were elevated (CRP 104mg/l (ref, <5)), white cell count 13.28x10^9/l (ref, 4 - 10)). DFO was confirmed clinically as all ulcers probed to bone. The patient completed multiple courses of oral antibiotics over 8 weeks without clinical improvement. Dalbavancin was given in the outpatient setting (1g on day 1, 500mg on day 8). Dalbavancin treatment was associated with a significant improvement in inflammatory markers (CRP 9 mg/l, WBC 9.27x10^9/l), and ultimately wound healing. Five months post administration, the ulcers have reduced in size (metatarsophalangeal (1.5cm x 3.8cm), hallux (0.2cm x 0.2cm) and second digit in remission). In this case study Dalbavancin was shown to successfully treat DFO. Dalbavancin has significant potential benefits over standard antimicrobial treatments, potentially eliminating the need for lengthy oral or intravenous antibiotic courses, reduced burden on Outpatient Parenteral Antimicrobial Therapy services, and avoidance of inpatient admission.