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11/08/2017    Ed Cohen, DPM

Orbactiv- A New Antibiotic Alternative

I treat numerous diabetic patients with gram
positivebacteria including MRSA infected foot
ulcers. Most of the digital ulcers can be
treated successfully with a MIS flexor tenotomy
and oral antibiotics. Some patients present with
associated bone infection and frequently need IV
antibiotics.

Until recently, this required a picc line and 6
weeks of daily IV infusions. Orbactiv is a new
antibiotic featuring a once dose protocol that is
as effective as 10-14 days of Vancomycin twice a
day. Orbactiv is less time-consuming, safer and
less expensive for my patients.

In contrast, IV Vancomycin can be nephrotoxic and
requires patient specific dosing based on Cr
clearance. I have successfully treated three bone
infections using Orbactiv. Two of the cases
required surgical biomechanical deformity
correction and amputation was avoided.

Recently, a 34 year old diabetic presented with
an ulcer on the bottom of the big toe. He was
under the care of an Infectious Disease and had
been going to a wound care clinic for 18 months.
He was treated with Levaquin, Bactrim DS and
Doxycycline and three months of hyperbaric oxygen
chamber sessions. His MRI displayed a bone
infection in the hallux. After 18 months of
failed treatment, the patient was scheduled for
an amputation and came to me for a second
opinion.

I ordered a single dose of Orbactiv and performed
MIS tendon balancing surgery three weeks later
employing a FHL tendon resection and medial
plantar fasciotomy. He received two additional
Orbactiv treatments. The patient was recently
admitted to the hospital in a diabetic coma.
Once the patient was stabilized the hospitalist
and infectious disease was consulted. The
Infectious disease doctor was elated that the
bone infection and ulcer had he was treating had
resolved.

Orbactiv is a good choice for the treatment of
culture pertinent infected diabetic ulcers and
usually avoids the need for a picc line with less
side effects such as nephrotoxicity that can be
associated with our renal deficient diabetics.

Ed Cohen, DPM, Gulfport, MS

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