Lower Extremity Infection

Minocycline and the Treatment of Multidrug-Resistant Acinetobacter baumannii

December 15, 2014

When most of us think about minocycline it is for the oral treatment of gram positive infection, in particular MRSA.  In fact, the drug is effective against multidrug resistant gram negative organisms, including Acinetobacter baumannii (AB). This point was driven home to me recently when I saw that my favorite ID journal Clinical Infectious Diseases just published a supplement on the topic.  Here is the link to the Table of Contents.  All of the articles are available as free full text and can be downloaded from this link: http://cid.oxfordjournals.org/content/59/suppl_6.toc#MINOCYCLINEFORTHETREATMENTOFMULTIDRUG-RESISTANTACINETOBACTERBAUMANNII This supplement was sponsored by The Medicines Company www.themedicinescompany.com who are now marketing an IV formulation of minocycline for this purpose so take that into account while reading the papers. That being said, both of the Guest Editors, Debra Goff, PharmD and Keith Kaye MD, MPH are top quality, fair balanced researchers and authors

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The Press Reporting of ID and Antibiotics

December 12, 2014

USA Today ran an interesting story yesterday about a 19 year old woman given an antibiotic by a friend for a “sore throat” who developed Stevens Johnson Syndrome.  This is a terrible incident and my thoughts and prayers go out to the young woman and her family.  What bothered me however was the way in which USA Today reported it.  Here is the link: http://www.usatoday.com/story/news/nation/2014/12/11/teen-antibiotic-burn-inside-out/20249585/ Yes, it was reported that there was a teen who took an antibiotic making her “Burn From the Inside Out” .  Talk about sensationalism!  It appears that they got that phrase from a physician they contacted.  Now, I’m not questioning the accuracy of that description but it is the use of it in the headline that makes me shake my head.  CNN reported the same story with a more sedate headline: “ A friend gave her an antibiotic; now she’s fighting for her life” http://www.cnn.com/2014/12/10/health/california-antibiotic-allergic-reaction/index.html?hpt=hp_t2 This just got me thinking about other ways in which the lay press reports on infectious diseases and antibiotics.  How many articles have been written on “Super Bugs”?  What ARE “super bugs” anyway?  In one story they may be MRSA, in another CREs.  What about “flesh eating bacteria”?  Some of us remember back about 15 years ago when this term first became popularly used in the press.  It referred to a series of cases of Group A Streptococcal necrotizing fasciitis.  This was hardly a new infection, even back then.  It has probably been around since the beginning of time but boy did they run with it.  Then, within the past few years “flesh eating bacteria” somehow morphed from Group A Strep to MRSA.  Which is it?  Is it both?  I guess. Finally, since I have been asked frequently, let’s look at Ebola.  Now I am not, and have never claimed to be an expert on viral diseases in general and Ebola in specific.  I have never seen or treated a case and hope to never come across it.  However, just a few weeks ago you could not turn on the TV, pick up a newspaper or magazine and not read about this terrible disease.  In fact, Time Magazine, rightly IMHO, just named those who fight Ebola as their “People of the Year”.  However, let’s put this into perspective.  To the best of my knowledge there were only TWO cases actually contracted in the US and both of those were health care workers directly treating the first unfortunate patient in Dallas.  That did not stop the news sources from rolling out expert after expert about how this disease could potentially spread here in the States, or maybe not.  People were freaking out.   For the first time in all my years of travel I was seeing folks wearing surgical masks on airplanes and taking out sanitizing wipes to treat the airplane seats and trays before sitting down (actually, probably not a bad idea!).  But, as the old saying goes, “today’s news is tomorrow’s fish wrapper”. Other than the Time story, I don’t think I have seen anything about the disease in a few weeks.

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Key Considerations With The Costs And Use Of Dalbavancin And Oritavancin

December 12, 2014

In my blog last month ( http://tinyurl.com/kknvjw9 ) I mentioned I would write a follow-up to discuss my opinions on the use of dalbavancin (Dalvance, Actavis) and oritavancin (Orbactiv, the Medicines Company) for lower extremity infections.

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Medscape Interview about Diabetic Foot Osteomyelitis

December 8, 2014

Just over a week ago my good friend and colleague in lower extremity ID, Mark Kosinski, DPM, FIDSA and I were interviewed by Miriam Tucker, a reporter for Medscape, about a recent paper that compared 6 weeks vs 12 weeks of antibiotic therapy for DFO that did not undergo surgical debridement.  The impetus for this interview was a study published in Diabetes Care by Tone, et.al.  Here are links to the PubMed abstract for that paper, and the original interview on Medscape along with a link to David Armstrong’s excellent “diabeticfootonline” blog where, with his permission and my thanks to him, I am cutting and pasting his reporting of this below. Although the article is a bit longer than my usual posting, I think it is worth reading as both Mark and I discuss what is unique and interesting about this excellent study

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Dalbavancin & Oritavancin – PART 2

November 17, 2014

In my post last week I mentioned I would write a follow up to discuss my opinions on the use of these drugs for lower extremity infections.  I have not yet had the opportunity to try either so these are really “top line” thoughts taken what I know, have read or heard from others, into consideration. – These drugs are expensive and I wonder who will cover the cost.

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New Antibiotics – Dalbavancin & Oritavancin PART 1

November 10, 2014

In this entry I will continue to explore some of the new antibiotics that have been recently approved for use in acute bacterial skin and skin structure infections (ABSSSI). I will discuss these two together since they are quite similar in a number of important ways and share many of the same properties. Both dalbavancin (Dalvance™ – Actavis) and oritavancin (Orbactive™ – The Medicines Company) are classified as “semisynthetic lipoglycopeptide” antibiotics

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ONYCHOMYCOSIS – What Are We Teaching?

November 3, 2014

I have been doing LOTS of talks on onychomycosis over the past few months. The vast majority of these have been CME lectures where I spend significantly more time reviewing the background information of onycho than talking about new drug therapies.  What has amazed me since I first started speaking on this topic over 25 years ago is the lack of understanding of the science behind this INFECTION.  Yes, you read that correctly…onychomycosis is an INFECTION and should be treated with anti-INFECTIVES.  We don’t think twice about treating a bacterial infection with an antibiotic, why don’t we feel as strongly about treating a fungal infection with an antifungal?  This has been my introductory statement in every lecture I give about this disease since I first became interested in this topic and my feeling has not waivered about it.

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New Antibiotics – Tedizolid

October 23, 2014

As I mentioned in my previous post, this has been a pretty exciting time in the area of lower extremity infectious diseases. Not only do we have 2 new drugs for onychomycosis (to be covered in future posts) but we also have 3 new FDA approved antibiotics for the treatment of, in FDA Speak; “acute bacterial skin and skin structure infections” (aBSSSI).  These drugs are tedizolid, dalbavancin and oritavancin.  Of these, the one that I am most interested in, at least at this moment, is tedizolid.

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Antibiotics And DFIs: What The Evidence Reveals

February 24, 2014

Given the prevalence of foot infections in patients with diabetes, aggressive and judicious management with antibiotics is crucial.

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‘Skin popping’ of the foot by drug abusers

February 22, 2014

Demographic description of the presentation and treatment of lower extremity skin and soft tissue infections secondary to skin popping in intravenous drug abusers. Pirozzi K1, Van JC1, Pontious J2, Meyr AJ3. J Foot Ankle Surg

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