Emerging Innovations In Treatment

By Brian McCurdy, Senior Editor

   As the podiatry profession continues to grow, new technologies emerge to help DPMs address key challenges in providing optimal care for their patients. These modalities include not only novel antibiotics to fight infection but a time-tested therapy that is just gaining prominence in the United States. Podiatrists may also enjoy the benefits of new cryogenic technology, wound care innovations and a re-emerging surgical procedure. Without further delay, let us take a closer look at these emerging innovations.

   1. Bacteriophage Therapy (Phage International). While there is no shortage of antibiotics to treat bacterial infection, DPMs may want to take another look at a non-antibiotic option for infection that recently debuted in the United States. Although bacteriophage therapy has been in use internationally for decades, it is just now being explored in the U.S. and made its debut earlier this year at the Diabetic Foot Global Conference (DFCon06) as well as the 19th Symposium on the Advancement of Wound Care.

   Bacteriophage therapy involves the use of lytic bacteriophage viruses that invade bacterial cells and disrupt the metabolism of the bacteria, according to Phage International. As David G. Armstrong, DPM, MS, PhD, notes, bacteriophage therapy essentially gives bacterium the “flu” and the targeted viruses evolve with the evolving bacterium, making resistance less of a problem.

   Although delivery issues still must be sorted out, Dr. Armstrong notes that phage technology is still “running at a good clip” in the Republic of Georgia, as well as in Eastern Europe. As Dr. Armstrong mentions, clinics near Tblisi in the Republic of Georgia have been using phage technology since the 1920s and it received much attention until the development of penicillin. Dr. Armstrong says bacteriophage therapy has intriguing promise when it comes to infected wounds in the lower extremity.

   “We are in an antimicrobial arms race,” says Dr. Armstrong, a Professor of Surgery, Chair of Research and Assistant Dean at the William M. Scholl College of Podiatric Medicine at the Rosalind Franklin University of Medicine in Chicago. “This race mandates that we develop more and more potent armaments to battle the enemy of bacteria. Unfortunately, these bacteria are smarter than we are and are perpetually a step ahead.”

   Although there can be bacterial resistance to phages, Phage International notes it only takes several weeks to develop new phages for resistant bacteria as opposed to several years to develop new antibiotics. The company also notes that for localized use, phages penetrate deeper when infection is present whereas antibiotics decrease in concentration below the surface.

Key Insights On Emerging Antibiotics

   2. Dalbavancin (Zeven, Vicuron/Pfizer). Given the rising incidence of complicated skin/skin structure infections (cSSSIs), it is vital to have a number of treatment options. One such option may be dalbavancin, which is currently being reviewed for a cSSSI indication by the Food And Drug Administration (FDA). Pfizer says the parenteral liopoglycopeptide antibiotic, which can treat gram-positive infections, has demonstrated “promising results” in phase III studies for cSSSIs.

   One advantage of dalbavancin is that patients can take it IV once a week, notes Warren Joseph, DPM, a Fellow of the Infectious Diseases Society of America. In regard to treating cSSSIs, Dr. Joseph says one clinical trial found that dalbavancin (dosed at 1 g IV followed by 500 mg IV at day seven) was as effective as linezolid (Zyvox, Pfizer) dosed at 600 mg IV or PO for 14 days. He says the study found cure rates in the range of 90 percent for dalbavancin and linezolid.1

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