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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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