Dalbavancin

INTRODUCTION: Dalbavancin is a new lipoglycopeptide that is active against Gram-positive pathogens, including methicillin-resistant Staphylococcus aureus. It has a half-life of 14.4 days, permitting intravenous treatment of acute bacterial skin and skin structure infections without the need for daily dosing.

Dalbavancin, a novel lipoglycopeptide, was approved in 2014 by regulatory agencies in the United States (USA) and Europe for the treatment of skin and skin structure infections. The activity of dalbavancin was also widely assessed against Streptococcus pneumoniae clinical isolates collected from patients on six continents monitored during two time intervals (2011-2013 and 2014). A total of 18,186 pneumococci were obtained from 49 nations and submitted to a monitoring laboratory as part of the SENTRY Antimicrobial Surveillance Program for reference susceptibility testing. Dalbavancin potency against S. pneumoniae was consistent across the monitored years with a MIC50/90 of 0.015/0.03 μg/ml and all isolates were inhibited at ≤ 0.12 μg/ml. The activity for dalbavancin was not adversely influenced by non-susceptibility to β-lactams (ceftriaxone or penicillin), macrolides, clindamycin, fluoroquinolones, tetracyclines or multidrug-resistance (MDR).

Antibacterial agents that kill non-dividing bacteria may be of utility in treating persistent infections. Oritavancin and dalbavancin are bactericidal lipoglycopeptides approved for acute bacterial skin and skin structure infections in adults caused by susceptible gram-positive pathogens. Using time-kill methodology, we demonstrate that oritavancin exerts bactericidal activity against methicillin-resistantStaphylococcus aureus(MRSA) isolates maintained in a non-dividing state in vitro whereas dalbavancin and the glycopeptide vancomycin do not.

Dalbavancin, an intravenous glycopeptide, was approved by the US Food and Drug Administration in May 2014 for use in adult patients with acute bacterial skin and skin structure infections. The recommended dosing regimen for effective use of dalbavancin is 1,000 mg followed by a 500 mg dose after 1 week. Two multinational, identically designed, non-inferiority trials, DISCOVER 1 and 2, demonstrated similar early clinical success with dalbavancin compared to vancomycin with an option to switch to oral linezolid. In a recently published non-inferiority trial, a single-dose regimen of dalbavancin was compared to the traditional two-dose administration and was found to have a non-inferior clinical response. In the aforementioned trials, dalbavancin was well tolerated, with patients experiencing transient adverse events of mild to moderate severity. The prolonged half-life, excellent skin and soft tissue penetration, bactericidal activity against Gram-positive bacteria including methicillin-resistant Staphylococcus aureus, and convenient dosing make dalbavancin a reasonable option for the treatment of acute bacterial skin and skin structure infections in adult patients who have tried and failed other therapies.