Oritavancin is a novel
lipoglycopeptide with activity against Gram-positive organisms including streptococci, methicillin-resistant Staphylococcus aureus, vancomycin-resistant S aureus (VRSA), and vancomycin-resistant enterococci (VRE) [1-3]. The US Food and Drug Administration approved
oritavancin as a single intravenous dose of 1200 mg for the treatment of acute bacterial skin and skin structure
infections on the basis of 2 clinical trials demonstrating noninferiority compared with
vancomycin [4, 5]. There are limited options for treatment of serious VRE
infections. Monotherapy with
daptomycin or
tigecycline or
linezolid may be sufficient in some cases, but combination
therapy is often indicated for severe or complicated
infections such as
endocarditis. Several
antibiotic combinations have been used in isolated case reports with some efficacy, including the following: high-dose
ampicillin with an
aminoglycoside [6],
ampicillin with
ceftriaxone or
imipenem [7, 8], high-dose
daptomycin with
ampicillin and
gentamicin [9] or with
gentamicin and
rifampin [10],
daptomycin with
tigecycline [11, 12],
quinupristin-dalfopristin with high-dose
ampicillin [13] or
doxycycline and
rifampin [14], and
linezolid with
tigecycline [15]. The limited efficacy, limited susceptibility, and extensive toxicities with many of these agents and combinations present barriers to effective treatment. Additional treatment options for VRE
endocarditis would be valuable. Although
oritavancin has been shown to have in vitro activity against some isolates of VRE, clinical data are lacking. We describe the first use of a prolonged course of
oritavancin in the treatment of a serious VRE
infection, prosthetic valve
endocarditis.