Dalbavancin

Summary

Dalbavancin is a semisynthetic lipoglycopeptide antibiotic with activity against gram-positive organisms including MRSA. It features an exceptionally long half-life (~346 hours), enabling once-weekly or single-dose dosing regimens. Approved for acute bacterial skin and skin structure infections (ABSSSI) in adults and pediatric patients.

Mechanism of Action

Inhibits bacterial cell wall synthesis by binding to the D-Ala-D-Ala terminus of peptidoglycan precursors, preventing transglycosylation and transpeptidation; also disrupts membrane integrity via its lipophilic side chain anchoring to the bacterial membrane

Routes of Administration

Goals & Uses

• OsteomyelitisAnti InfectiveModerate
• Native and prosthetic valve endocarditis (off-label)Anti InfectiveLow
• Acute bacterial skin and skin structure infections (ABSSSI)Anti InfectiveHigh
• MRSA infectionsAnti InfectiveHigh
• Outpatient parenteral antibiotic therapy (OPAT)Anti InfectiveModerate

Contraindications

• Hypersensitivity to other glycopeptides (e.g., vancomycin)AllergyModerate
• Known hypersensitivity to dalbavancinAllergyHigh

Adverse Effects

• HepatotoxicityHepaticUncommonLiver injury or dysfunction
• Hypersensitivity/anaphylaxisImmunologicalRare
• HeadacheNeurologicCommonPain in the head or upper neck
• NauseaGastrointestinalCommonFeeling of sickness or urge to vomit
• DiarrheaGastrointestinalCommonLoose or frequent stools
• Infusion-related reactions (Red Man Syndrome)Infusion ReactionUncommon

Drug Interactions

• WarfarinLow
• VancomycinLow

Population Constraints

• PregnancyReproductive SafetyRelative
• Hepatic impairment (moderate to severe)Organ ImpairmentRelative
• Pediatric patients <6 monthsPediatricRelative
• Renal impairment (CrCl <30 mL/min, not on dialysis)RenalRelative

Regulatory Status

• European UnionApprovedApproved: Treatment of acute bacterial skin and skin structure infections (ABSSSI) in adultsEMA approved 2015; marketed as Xydalba
• United StatesApprovedApproved: Acute bacterial skin and skin structure infections (ABSSSI) in adults and pediatric patientsFDA approved May 2014; pediatric extension 2019; marketed as Dalvance
• United KingdomApprovedApproved: Acute bacterial skin and skin structure infections (ABSSSI) in adultsApproved post-EMA; available as Xydalba

FDA approved in May 2014 for ABSSSI in adults; indication extended to pediatric patients in 2019. EMA approved under the brand name Xydalba.

Evidence & Sources

No sources recorded yet.