Photosensitivity During Quinolone Therapy in Diabetic Foot Patients May Falsely Indicate Treatment Failure.

Acute bacterial skin and skin structure infections (ABSSSI), also referred to as skin and soft tissue infections, or skin and skin structure infections, with or without osteomyelitis (OM) in diabetic foot are complications of diabetes. Quinolones are a widely used class of antibiotics in ABSSSI and OM, and photosensitivity is among their adverse reactions. Its appearance may falsely indicate treatment failure. We describe 2 such cases. The first patient is a 49-year-old male with type 2 diabetes mellitus (DM), who presented with left lower limb ulcer with fever (39 °C) over a week. He began treatment with ciprofloxacin, clindamycin, and linezolid. Although his clinical condition and laboratory tests improved, the redness of the left lower limb increased. Clinical examination revealed redness on the face and the parts of the body that had been exposed to sunlight. The patient continued the same antimicrobial therapy and was given instructions to avoid exposure to sunlight. Redness and infection improved, and the patient was discharged. The second case is a 72-year-old male with a history of type 2 DM, admitted to hospital because of an infected ulcer of the first toe of the right limb. The patient received intravenous treatment with levofloxacin and clindamycin. On the fourth hospital day, the patient presented redness (with eczematous plaques) on his left lower limb. Clinical examination revealed that the patient's bed was placed near a window and his left limb was exposed to direct sunlight. Patient's bed was changed to avoid sun exposure. Symptoms began to improve over the next few days.

Successful Treatment of Diabetic Foot Osteomyelitis with Dalbavancin.

INTRODUCTION: Dalbavancin is a new antibiotic against multi-drug resistant Gram (+) bacteria. Dalbavancin has an extremely long half-life. Current indication is skin and soft tissue infections (ABSSSI), but researchers have successfully administered it off-label to osteomyelitis (OM) patients. AIM: We present a case of successful treatment of diabetic foot (DF) OM. CASE REPORT: A 53-year-old male presented to our DF clinic, with recently diagnosed diabetes mellitus, with very bad glycaemic control (HbA1c=12,5%). He had diabetic neuropathy, but no peripheral arteriopathy. Two months before, because of an accident with hot water, he presented left foot ulcer, followed by ABSSSI and 1st toe and 1st metatarsal OM (plain x-ray findings). A multi-drug resistant Enterococcus faecium was isolated in cultures and a targeted treatment with tigecycline and daptomycin was administered. The patient also received 1,5 gr dalbavancin upon discharge. 2 weeks later, he continued treatment at home with linezolid and tedizolid. A complete medical record with patient's history, informed consent and relative literature was sent to Greek National Health Care Organization (EOPYY), requesting administering off-label another 1,5 gr dalbavancin. In the meanwhile, he was admitted for iv tigecyclin, and continued treatment with linezolid at home. He finally received a second dose of 1,5 g dalbavancin. Patient received totally 14 weeks' targeted therapy, mostly off-hospital. When he completed treatment, foot was in excellent condition and x-ray had significantly improved. CONCLUSION: Dalbavancin, due to its extremely long half-life, could potentially be the drug of choice for OM caused by multi-drug resistant Gram (+) cocci, in order to avoid hospitalization, especially on non-complient patients. Further research is necessary.