OSTEOMYELITIS IN MY BIG TOE: DIABETES; VANCOMYCIN
Submitted questions via the “Quick Contact – Osteomyelitis.com” form at: http://www.osteomyelitis.com/html/about.html
Greeting: I was informed this morning that I have osteomyelitis in the bottom of my big toe and they want to put a PICC line in by 1:30pm today and start giving me Vancomycin. I am very concerned about the effect this medication will have on my kidneys and hearing. I am sixty and they claim I have diabetes; but I am very healthy and eat well. Please let me know how you feel about this approach, and what would you do if you were me. My doctor told me that if I don’t have the procedure done today the infection could spread to my foot and lead to an amputation of my foot; she also said it could get into my bloodstream and destroy my kidneys… is all this true?
Dr. Cierny’s reply: Yes —- I agree that pathogen-specific antibiotics will, indeed, help to control the spread of infection, particularly in patients with a compromise in wound-healing (like even mild, diabetics). There is, however, no reason to be exposed to the added risks of a PICC line and being exposed to the toxicity of the antibiotic, Vancomycin, unless cultures from your infection have grown a resistant Staphylococcus (MRSA or MRSE) or an Enterococcus species. If you have a sensitive Staphylococcus organism causing the infection, it will be better not to treat it with Vancomycin; other drugs are both more effective and less risky.
If you have had the wound (and osteomyelitis) for more than 4 weeks, it is likely the infection has already gone beyond at point that can still be cured with the use of antibiotics, alone. Please ask your present doctor (infectious disease specialist?) to refer you to an orthopaedic surgeon who specializes in foot and ankle surgery and do it sooner, rather than later. See also, HOW TO MANAGE CHRONIC MEDULLARY OSTEOMYELITIS in this blog to get a feel for why infections become refractory to antibiotic treatment. GC 9/03/09