Severe malaria, artesunate and haemolysis.

on two occasions, and the dose was adjusted accordingly a few times. He presented 2 weeks later with worsening symptoms of the right knee, including redness, swelling and pain. He was switched to 10 mg/kg telavancin intravenously every 24 h and rifampicin was continued. The MIC of telavancin was 0.25 mg/L. During the 6 week therapy with telavancin, the patient showed rapid improvement of symptoms and signs at 2, 4 and 6 week follow-up visits, and antibiotic was discontinued at 6 weeks with resolution of infection. His WBC count returned to normal, C-reactive protein (CRP) decreased from 7 to 0.2 mg/L and the erythrocyte sedimentation rate (ESR) decreased from 60 to 8 mm/h. He had no significant side effects. The patient was symptom free on his subsequent visits at 6 months and 1 year after finishing therapy, with normal WBC count, ESR and CRP. Coagulase-negative staphylococci (30%–43%) followed by Staphylococcus aureus (12%–23%) are the most commonly cultured microorganisms in prosthetic joint infections. Telavancin is a semi-synthetic lipoglycopeptide derived from vancomycin with activity against Gram-positive bacteria, including strains with reduced susceptibility to vancomycin. It exerts its antibacterial activity by two mechanisms: by inhibiting cell wall synthesis and increasing membrane permeability. Telavancin retains potent activity against methicillin-resistant S. aureus isolates with vancomycin MICs of 2 mg/L. It displays concentration-dependent bactericidal killing, a 7.5 h half-life and a post-antibiotic effect of 4–6 h, allowing for once-daily dosing. Taste disturbance, nausea, headache, foamy urine and reversible kidney injury are the most commonly observed adverse events. We believe this is the first reported case in the literature using telavancin successfully for the treatment of prosthetic knee joint infection without removal of the hardware, which is usually needed for eradication of the infection.