Successful Treatment of Methicillin Susceptible Staphylococcus aureus Osteomyelitis with Oritavancin

Staphylococcus aureus remains the most common causative pathogen in osteomyelitis. New or alternative therapies are often needed to treat S. aureus infections adequately in patients with drug allergies, treatment failures, or drug interactions. Oritavancin is a novel long-acting lipoglycopeptide approved by the U.S. Food and Drug Administration in 2014 for the treatment of acute bacterial skin and skin structure infections. With a terminal half-life of 8-10 days, oritavancin dosing regimens with infrequent parenteral administration now exist to treat infectious diseases such as osteomyelitis that would otherwise require daily dosing of intravenous antimicrobials for weeks; however, clinical experience is lacking. In this article, the first case of S. aureus osteomyelitis resulting from traumatic injury, successfully treated with oritavancin, is presented. Removal of the nail used for a comminuted tibial shaft fracture repair followed by a 6-week treatment course with oritavancin resulted in clinical response.