Role of Oritavancin in the Treatment of Infective Endocarditis, Catheter- or Device-Related Infections, Bloodstream Infections, and Bone and Prosthetic Joint Infections in Humans: Narrative Review and Possible Developments

Abstract

Oritavancin is a long-acting lipoglycopeptide with in vitro activity against Gram-positive pathogens, as well as good bactericidal activity and sterilisation ability in biofilm. It has been approved for acute bacterial skin and skin structure infections (ABSSSI), but recent reports have demonstrated possible off-label uses, such as for vancomycin resistant enterococci (VRE), deep-seated infections including those involving prosthetic material and invasive infections. The aim of this work is to review the uses of oritavancin outside of ABSSSI, focusing on its real-life applications on infective endocarditis, catheter- or device-related infections, bloodstream infections, and bone and prosthetic joint infections in humans, as well as possible future applications. We performed a narrative review, collecting the literature published between 1 December 2002 and 1 November 2022 on PubMed and the Cochrane Library using the term ‘oritavancin’. Available studies have shown how effective it is in different settings, suggesting an opportunity for step-down strategies or outpatient management of infections requiring a long duration of antibiotic treatment. So far, evidence is still scarce, and limited to a few studies and case reports, mostly focusing on Staphylococcus aureus as the major isolate. Concerns about fluid intake for dilution and interaction with coagulation markers also need to be taken into account. Further studies are required in order to assess the safety and effectiveness of Oritavancin in vascular, prosthetic, or device-related infections, as well as in resistant Gram-positive bacteria or enterococcal infections.

The Clinical Efficacy of Multidose Oritavancin: A Systematic Review

“…A recent narrative review on the use of ORI in the treatment of non-ABSSSI infections has just been published, but the issue of multiple doses has not been discussed [23].…”

“…PK/PD properties and the safety profile of ORI, then, make it therapeutically attractive to offer therapeutic options beyond its single dose use. ORI use in the treatment of complicated infections such as bacteremia, endocarditis, pneumonia, osteomyelitis and surgical site infections is currently under investigation, and several case reports or case series exist [23]. Nevertheless, the severity and high relapse rates of these latter infections may require more than a single dose of treatment.…”

Comprehensive Study of Drug-Induced Pruritus Based on Adverse Drug Reaction Report Database

“…Oritavancin diphosphate (Oritavancin) is a semi-synthetic, long-acting lipoglycopeptide (LGP) with potent activity against Gram-positive pathogens such as methicillinresistant Staphylococcus aureus. It operates through three distinct mechanisms: (i) obstructing cell wall synthesis by binding to the peptide stems of peptidoglycan precursors, (ii) hampering the peptide transfer (cross-linking) phase of cell wall formation by binding to peptide cross-links within the cell wall, and (iii) rapid cell death attributable to the disruption of bacterial membrane integrity [25]. While our exploration did not reveal any reports suggesting a connection between pruritus and this mechanism of action, pruritus did emerge as an adverse event during a phase III international multicenter randomized double-blind clinical trial.…”

Enterococcus spp. and Streptococcus spp. bloodstream infections: epidemiology and therapeutic approach

“…These antibiotics, dalbavancin and oritavancin have been studied mostly in consolidation of IE with good results. The doses have not yet been fully clarified and differ between different trials [ 15 , 16 ].…”