Osteomyelitis is a difficult-to-treat disease that can require both surgical
debridement and a prolonged course of antimicrobial
therapy. Current standard of care for the antimicrobial treatment of
osteomyelitis is fraught with multiple challenges and limitations. Patients typically require the insertion of an
indwelling catheter for single or multiple daily intravenous
antibiotic infusions for up to 6 weeks. Currently, there are treatment guidelines for only vertebral
osteomyelitis, indicating the complexity of the condition.
Oritavancin is a long-acting, second-generation
lipoglycopeptide, administered intravenously once per week, which has potential to be a useful alternative in the treatment of
osteomyelitis. This article reviews occurrence and outcomes of off-label
oritavancin use for treatment of
osteomyelitis as described in case reports. Analysis included 23 patients treated for
osteomyelitis with single- or multiple-dose
oritavancin. Overall, clinical cure or improvement was achieved in 87% of patients, and adverse events were mild and reported in only two patients. Clinical efficacy was demonstrated in 81.8% of methicillin-resistant Staphylococcus aureus (MRSA), 71.4% of
methicillin-sensitive S. aureus (MSSA), 50% of
vancomycin-resistant Enterococcus (VRE), and in the single case of Streptococcus pyogenes.
Oritavancin has shown efficacy against Gram-positive pathogens in
osteomyelitis, and offers a possible outpatient treatment option for
osteomyelitis patients. Future studies are needed to determine dosing frequency in
osteomyelitis patients.