Efficacy and Safety of Dalbavancin Monotherapy as Salvage Treatment for Bone and Joint Infection

Abstract

Bone and joint infection (BJI) treatment is challenging with significant morbidity and mortality. Dalbavancin is a semi-synthetic lipoglycopeptide analogue of the teicoplanin class that exhibits bactericidal activity and a long half-life. The use of dalbavancin may be an option in cases of gram-positive BJI. From November 2017 to April 2019, dalbavancin was used in monotherapy as a salvage option for BJI, as follows: 1500 mg, 1st (D1) and 8th (D8) days, repeated if needed. The follow-up period was of 6 months for osteomyelitis and 1 year for prosthetic joint infections (PJIs). The demographics of the 16 patients showed that 75% were men (n=12), with a mean age of 77.8 years . The BJI characteristics: 5 cases of vertebral osteomyelitis; 12 cases of lower limb BJI {8 joint infections, among which were 6 PJIs (4 knees, 2 hips) and 4 cases of foot osteomyelitis)}; 2 cases of shoulder PJI. The debridement, antibiotics, irrigation, and implant retention (DAIR) procedure was performed in 83.4% (5/6) of cases. Monobacterial biopsy was obtained in 75% (n=12) of patients with majority of staphylococcus (15/25) dalbavancin susceptible micro-organismes): 14 Staphylococcus aureus (10/14 methicillin susceptible). Twelve patients received 2 doses of dalbavancin. The mean duration of the 1st antibiotherapy was 18.3 days [0-49]. The clinical success rate was 75% at the end of follow-up with no major side effects of dalbavancin. This report highlights the potential role and efficiency of dalbavancin in treating fragile patients who require long-term antimicrobial therapy with excellent tolerance profiles.

Effectiveness and safety of dalbavancin in France: a prospective, multicentre cohort study

“…While these trials provide valuable information regarding tolerability, efficacy data cannot be extrapolated for infections other than ABSSSIs. However, realworld studies showed that dalbavancin has been used for the treatment of other bacterial infections, such as bone and joint infections, prosthetic joint infections, osteomyelitis, and endocarditis [13][14][15][16][17][18]. Linezolid, also originally approved for ABSSSIs, is a striking example of an Accepted manuscript 5 antibiotic with extensive off-label use [19], which subsequently required additional research efforts to characterize its efficacy and tolerability in other indications [20].…”

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“…Esophageal cancer (esophageal carcinoma) is the tenth most common cancer worldwide and the sixth leading cause of cancer-related deaths [1]. However, most esophageal cancers are detected at an advanced stage, when treatment options are limited and prognosis is poor, and conventional synchronized chemoradiotherapy or induction chemotherapy in combination with it does not improve the response rate or survival of patients [2].…”