The role of dalbavancin for Gram positive infections in the COVID-19 era: state of the art and future perspectives

Andreoni, Massimo; Bassetti, Matteo; Corrao, Salvatore; Rosa, Francesco Giuseppe De; Esposito, Vincenzo; Falcone, Marco; Grossi, Paolo; Pea, Federico; Petrosillo, Nicola; Tascini, Carlo; Venditti, Mario; Viale, Pierluigi

doi:10.1080/14787210.2021.1894130

Cited by 13 publications

(6 citation statements)

References 52 publications

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“…Dalbavancin (DBV) is a long-acting parenteral lipoglycopeptide LGP. It was first approved by the Food and Drug Administration (FDA) in 2014 for acute bacterial skin and skin structure infections (ABSSSI), DBV has gradually acquired over the years a role as an off-label treatment for several infections caused by Gram-positive bacteria [ 1 , 2 ]. The mechanism of action of DBV involves the inhibition of peptidoglycan cross-linking in the bacterial cell wall [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Dalbavancin in Bone and Joint Infections: A Systematic Review

et al. 2023

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Background: Approved for acute bacterial skin and skin structure infections, dalbavancin (DBV) has gradually acquired over the years a role as an off-label treatment for several infections caused by Gram-positive bacteria even in other anatomical sites. Osteoarticular (OA) infections are one of the most difficult-to-treat infections and, since the absence of recommendations, clinicians use different and heterogenic DBV dosing schedule regimens for the off-label treatment of osteomyelitis, spondylodiscitis, and septic arthritis. Our aim is to systematically review the current literature to describe DBV administration schedules and their outcome in OA infections. Methods: According to the 2020 updated PRISMA guidelines, all peer-reviewed articles regarding the use of DBV in OA infections were included. We conducted a literature search on PubMed and Cochrane Controlled Trials. Results: A total of 23 studies and 450 patients were included, prevalently male (144/195, 73.8%) and diabetic (53/163, 32.5%). Overall, 280 (280/388, 72.2%) osteomyelitis, 79 (79/388, 20.4%) spondylodiscitis, and 29 (29/388, 7.5%) septic arthritis were considered. Staphylococcus aureus (164/243, 67.5%) was the most common pathogen isolated. A previous treatment failure (45/96, 46.9%) was the main reason for a switch to a long-acting antibiotic. Most patients were successfully cured with DBV (318/401, 79.3%). A source control was performed in most patients with a favourable outcome (80.4%), while MRSA was prevalently isolated in people with an unfavourable outcome (57%). While a higher percentage of success was found in people who received three doses of DBV 1 week apart (92.3%), a higher rate of treatment failure was recorded in cases of when the DBV cycle was composed of less than two or more than four doses (27.8%). Conclusions: DBV has shown to be effective as a treatment for OA infections. The most favourable outcome was found in patients receiving three doses of DBV and with an adequate surgical management prior to antibiotic treatment. Although a rigorous administration schedule does not exist, DBV is a viable treatment option in the management of OA infections.

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Section: Introductionmentioning

confidence: 99%

Dalbavancin in Bone and Joint Infections: A Systematic Review

et al. 2023

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“…The use of dalbavancin has also been explored in relation to the COVID-19 era. The new infection control and hospital resource preservation requirements that emerged due to the pandemic are partially met by the fact that dalbavancin has an exceptionally long half-life that allows for its use in patients in OPAT programs, thus, reducing the spread of nosocomial infections due to a shortened length of a hospital stay [13,[33][34][35].…”

Section: Introductionmentioning

confidence: 99%

Real-World Data Regarding Dalbavancin Use before and during the COVID-19 Pandemic—A Single-Center Retrospective Study

et al. 2023

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Dalbavancin is a semisynthetic lipoglycopeptide, which possesses great potential for bactericidal activity similar to antimicrobials with the same mechanism of action, such as vancomycin and teicoplanin. Due to its very prolonged half-life, it can be used in a single or two-dose regimen to treat infections by Gram-positive microorganisms, even resistant ones, such as methicillin-resistant Staphylococcus aureus (MRSA). Currently, it is approved only for the treatment of acute bacterial skin and skin structure infections (ABSSSIs). The aim of this study was to investigate the clinical and microbiological characteristics of patients to whom dalbavancin was administered at the University Hospital of Heraklion and evaluate its use in regard to the COVID-19 pandemic. In total, 146 patients were included in this retrospective cohort study evaluating the use of dalbavancin from the first time it was used in 2017 until the end of 2022. The median age was 68 years (range: 21–96 years), and 86 (59%) patients were male. The most common indications for dalbavancin use were osteoarticular infections in 43%, followed by ABSSSIs in 37%, and cardiovascular infections in 10%. Dalbavancin was used empirically in one out of three patients, most commonly with the indication of ABSSSIs, and most commonly in the post-COVID-19 era. The most frequently isolated pathogens were coagulase-negative staphylococci in 70%, S. aureus in 27%, Enterococcus spp. in 22%, and Streptococcus spp. in 8%, while one out of three infections were polymicrobial. In 12% of patients, the infection was not cured, but no patients died. For patients with ABSSSIs, endocarditis and vascular infections, and bacteremia, the cure rates were more than 90%, and in osteoarticular infections, the cure rate was 76%. Thus, dalbavancin has great potential for use in complicated and invasive infections that may require prolonged intravenous antimicrobial treatment. However, further studies are required to formally investigate its role in such infections.

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“…Dalbavancin is a novel, long-acting lipoglycopeptide active against Gram-positive pathogens, including multi-drug resistant isolates. 1 Long elimination half-life and good tissue penetration represent the main pharmacokinetic features of dalbavancin, 2 allowing for long-term efficacy despite the simplified weekly administration regimens. It was approved by the US Food and Drug Administration and the European Medicines Agency in 2014 and 2015 for the management of acute bacterial skin and skin structure infections (ABSSSIs) on an intravenous dosing regimen of 1500 mg as a single infusion or 1000 mg followed by 500 mg one week apart.…”

Section: Introductionmentioning

confidence: 99%

Real-World Use of Dalbavancin in the Era of Empowerment of Outpatient Antimicrobial Treatment: A Careful Appraisal Beyond Approved Indications Focusing on Unmet Clinical Needs

Gatti

Andreoni

Pea

et al. 2021

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Dalbavancin is a novel, long-acting lipoglycopeptide characterized by a long elimination half-life coupled with excellent in vitro activity against multidrug-resistant Gram-positives. Although it is currently approved only for the treatment of acute bacterial skin and skin structure infections, an ever-growing amount of evidence supports the efficacy of dalbavancin as a long-term therapy in osteomyelitis, prosthetic joint infections, endocarditis, and bloodstream infections. This article provides a critical reappraisal of real-world use of dalbavancin for off-label indications. A search strategy using specific keywords (dalbavancin, osteomyelitis, endocarditis, long-term suppressive therapy, bloodstream infection, pharmacokinetic/pharmacodynamic profile) until April 2021 was performed on the PubMed-MEDLINE database. As for other novel antibiotics, a conundrum between approved indications and potential innovative therapeutic uses has emerged for dalbavancin as well. The promising efficacy in challenging scenarios (i.e., osteomyelitis, endocarditis, prosthetic joint infections), coupled with the unique pharmacokinetic/pharmacodynamic properties, makes dalbavancin a valuable alternative to daily in-hospital intravenous or outpatient antimicrobial regimens in the treatment of long-term Gram-positive infections. This makes dalbavancin valuable in the current COVID-19 scenario, in which hospitalization and territorial medicine empowerment are unavoidable.

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The role of dalbavancin for Gram positive infections in the COVID-19 era: state of the art and future perspectives

Cited by 13 publications

References 52 publications

Dalbavancin in Bone and Joint Infections: A Systematic Review

Dalbavancin in Bone and Joint Infections: A Systematic Review

Real-World Data Regarding Dalbavancin Use before and during the COVID-19 Pandemic—A Single-Center Retrospective Study

Real-World Use of Dalbavancin in the Era of Empowerment of Outpatient Antimicrobial Treatment: A Careful Appraisal Beyond Approved Indications Focusing on Unmet Clinical Needs

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