In Spring 2019, the Pharmacy and Therapeutics Committee voted to add Dalbavancin to the formulary of the outpatient infusion center. Its use is currently restricted to prescribers from Infectious Diseases services only.
Dalbavancin is a lipoglycopeptide antibiotic derived from teicoplanin, an analog of vancomycin. It possesses a similar spectrum of activity to vancomycin with potent activity against Gram-positive microorganisms, including Streptococcus spp., Enterococcus spp., and both methicillin-susceptible and -resistant Staphylococcus aureus (MSSA and MRSA). It also has activity against some vancomycin-intermediate S. aureus (VISA). However, it is not active against most vancomycin-resistant Enterococcus spp. and all Gram-negative pathogens. It is currently indicated for the treatment of acute bacterial skin and skin structure infections (ABSSSIs). In two phase III trials that informed its approval, dalbavancin was shown to be non-inferior to intravenous (IV) vancomycin with optional switch to oral linezolid. Additionally, data has become available suggesting that it may also have a role in the treatment of other sources of infection, most notably osteomyelitis and endocarditis.
The pivotal clinical trials for the use of dalbavancin in ABSSSI showed that it was generally well tolerated, demonstrating that the majority of adverse effects were designated as mild or moderate. The most common reported were rash, headache, nausea, vomiting, and diarrhea.
In comparison to the other antibacterial agents that also have activity against resistant Gram-positive pathogens such as vancomycin, daptomycin, linezolid, tedizolid, telavancin, and oritavancin, positive characteristics of dalbavancin include:
- Extended half-life
- Once weekly dosing
- Short infusion time (30 minutes)
- Favorable adverse effect profile
- Does not prolong prothrombin time (PT) or activated partial thromboplastin time (aPTT)
- No dosage-adjustment recommended for hemodialysis
- Therapeutic drug monitoring is not routinely indicated