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Cellulitis Case Study

44-year old male with renal insufficiency

Background

  • Patient is a 44-year-old single father with chronic renal insufficiency. He tripped and fell while doing yard work and scraped his right leg. He has hyperlipidemia and atrial fibrillation. He is on rosuvastatin and apixaban.

Presentation

  • Patient presented to his Primary Care Physician (PCP) with an infected right leg abrasion. PCP prescribed oral cephalexin. Patient presented to the ED 2 days later with an enlarged lesion and low-grade fever.

Evaluation

  • Spreading erythematous lesion over 200 cm2 in size
  • Lesion is warm and tender
  • BP: 128/86 mmHG
  • RR: 18/min
  • HR: 110/min
  • BMI: 29 kg/m2
  • Temp: 99.8° F
  • CrCl: 32ml/min

Diagnosis and treatment considerations

  • Post-traumatic cellulitis
  • Presumed gram-positive cocci, including streptococci/staphylococci, possibly MRSA
  • Physician feels severity of infection warrants an IV antibiotic
  • Patient prefers not to be admitted or have to return for multiple infusions

Resolution of cellulitis infection following administration of single dose ORBACTIV®

At presentation

Actual SOLO patient picture

48-72 hours

Actual SOLO patient picture

7-10 days

Actual SOLO patient picture

14-24 days

Actual SOLO patient picture

This hypothetical case study is meant to be illustrative of an actual patient treated with a single 1200mg dose of ORBACTIV® in the SOLO trials. It is not intended to offer medical advice. Determination of appropriate treatment is at the discretion of the physician. Results presented are consistent with results observed in the SOLO trials of patients with ABSSSI. In the SOLO I and SOLO II trials the clinical response rates at 14-24 days for patients receiving ORBACTIV® were 79.6% and 82.7% respectively. Click here to see clinical study results from the SOLO trials. Individual results may vary.

Download a PDF of this case study here.

Background

  • Patient is a 44-year-old single father with chronic renal insufficiency. He tripped and fell while doing yard work and scraped his right leg. He has hyperlipidemia and atrial fibrillation. He is on rosuvastatin and apixaban.

Presentation

  • Patient presented to his Primary Care Physician (PCP) with an infected right leg abrasion. PCP prescribed oral cephalexin. Patient presented to the ED 2 days later with an enlarged lesion and low-grade fever.

Evaluation

  • Spreading erythematous lesion over 200 cm2 in size
  • Lesion is warm and tender
  • BP: 128/86 mmHG
  • RR: 18/min
  • HR: 110/min
  • BMI: 29 kg/m2
  • Temp: 99.8° F
  • CrCl: 32ml/min

Diagnosis and treatment considerations

  • Post-traumatic cellulitis
  • Presumed gram-positive cocci, including streptococci/staphylococci, possibly MRSA
  • Physician feels severity of infection warrants an IV antibiotic
  • Patient prefers not to be admitted or have to return for multiple infusions

INDICATION AND USAGE

ORBACTIV® (oritavancin) is indicated for the treatment of adult patients with acute bacterial skin and skin structure infections (ABSSSIs) caused or suspected to be caused by susceptible isolates of the following Gram-positive microorganisms: Staphylococcus aureus (including methicillin-susceptible [MSSA] and -resistant [MRSA] isolates), Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus dysgalactiae, Streptococcus anginosus group (includes S. anginosus, S. intermedius, and S. constellatus), and Enterococcus faecalis (vancomycin-susceptible isolates only).

To reduce the development of drug-resistant bacteria and maintain the effectiveness of ORBACTIV® and other antibacterial drugs, ORBACTIV® should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria.

Important Safety Information

Contraindications

Use of intravenous unfractionated heparin sodium is contraindicated for 120 hours (5 days) after ORBACTIV® administration because the activated partial thromboplastin time (aPTT) test results are expected to remain falsely elevated for approximately 120 hours (5 days) after ORBACTIV® administration.

ORBACTIV® is contraindicated in patients with known hypersensitivity to ORBACTIV®.

Warnings and Precautions

Coagulation test interference: ORBACTIV® has been shown to artificially prolong aPTT for up to 120 hours, and may prolong PT and INR for up to 12 hours, and ACT for up to 24 hours. ORBACTIV® has also been shown to elevate D-dimer concentrations up to 72 hours.

Hypersensitivity reactions, including anaphylaxis, have been reported with the use of antibacterial agents including ORBACTIV®. Discontinue infusion if signs of acute hypersensitivity occur. Monitor closely patients with known hypersensitivity to glycopeptides.

Infusion Related Reactions: Administer ORBACTIV® over 3 hours to minimize infusion-related reactions. Infusion reactions characterized by chest pain, back pain, chills and tremor have been observed with the use of ORBACTIV®, including after the administration of more than one dose of ORBACTIV® during a single course of therapy. Stopping or slowing the infusion may result in cessation of these reactions.

Clostridium difficile-associated diarrhea: Evaluate patients if diarrhea occurs.

Concomitant warfarin use: ORBACTIV® has been shown to artificially prolong PT and INR for up to 12 hours. Patients should be monitored for bleeding if concomitantly receiving ORBACTIV® and warfarin.

Osteomyelitis: Institute appropriate alternate antibacterial therapy in patients with confirmed or suspected osteomyelitis.

Prescribing ORBACTIV® in the absence of a proven or strongly suspected bacterial infection is unlikely to provide benefit to the patient and increases the risk of development of drug-resistant bacteria.

Adverse Reactions

The most common adverse reactions (≥3%) in patients treated with ORBACTIV® were headache, nausea, vomiting, limb and subcutaneous abscesses, and diarrhea.

See Full Prescribing Information

INDICATION

ORBACTIV® (oritavancin) for injection is indicated for the treatment of adult patients with acute bacterial skin and skin structure infections (ABSSSI) caused or suspected to be caused by susceptible isolates of the following gram-positive microorganisms: Staphylococcus aureus (including methicillin-susceptible [MSSA] and -resistant [MRSA] isolates), Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus dysgalactiae, Streptococcus anginosus group (includes S. anginosus, S. intermedius, and S. constellatus), and Enterococcus faecalis (vancomycin-susceptible isolates only).

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