Dalbavancin

Dalbavancin is a semi-synthetic lipoglycopeptide antibiotic obtained by fermentation with Nonomuraea bacteria and subsequent chemical modification. It belongs to the same class as vancomycin(glycopeptide), which is the most widely used and one of the few available treatments for patients infected with methicillin-resistant Staphylococcus aureus(MRSA).

Dalbavancin has in vitro activity against a variety of Gram-positive bacteria, including MRSA and methicillin-resistant Staphylococcus epidermidis (MRSE).

The Food and Drug Administration (FDA) approved Dalbavancin in May 2014 for the treatment of acute bacterial skin and skin structure infections (ABSSSIs) caused by Staphylococcus aureus, including methicillin-sensitive and methicillin-resistant strains of Streptococcus pyogenes.

In adults 1500 mg dalbavancin either 1500 mg once or 1000 mg followed by 2nd dose with 500 mg after 1 week

Elderly patients:

• Dose adjustment not necessary

Slight or moderate kidney dysfunction:

• Dose adjustment not necessary (creatinine clearance >/= 30 - 79 ml / min)
• Patients receiving regular haemodialysis (3 times/week): Dose adjustment not necessary; Dalbavancin can be used regardless of the time of haemodialysis
• Patients with chronic renal dysfunction whose creatinine clearance is < 30 ml / min and who do not receive regular hemodialysis: reduce dose to either 1000 mg, administered as a single infusion or to 750 mg, followed by a second dose of 375 mg after 1 week

Liver failure:

• mild liver failure (Child-Pugh A no dose adjustment recommended
• moderate or severe liver failure (Child-Pugh B & C): caution is advised as no data are available to determine appropriate dosage
• Children and adolescents </= 18 years: safety and efficacy not yet proven; dosage recommendation cannot be given

The main side effects are:

• Development of resistance
• pseudomembranous colitis
• Hypersensitivity reactions.

The most common side effects (can affect 1 to 3 in 100 people) are:

• Nausea
• Diarrhoea
• Headache.

• Minor: Dalbavancin /Chinidine
• Dalbavancin /Ciclosporin
• Cholesterol synthesis inhibitor /Dalbavancin
• Dalbavancin /Verapamil
• Dalbavancin /Azole antifungals
• Dalbavancin / macrolide antibiotics
• Digitalis-Glycosides /Dalbavancin

Hypersensitivity to Dalbavancin

The different names reflect where the research was carried out: MDL refers to Merrell-Dow-Lepetite, where the original complex was discovered; BI refers to BioSearch Italia, where Dalbavancin itself was first synthesized; VER refers to Versicor (with which Biosearch Italia merged to create Vicuron Pharmaceuticals).

1. Huang V et al (2020) Glycopeptides Hypersensitivity and Adverse Reactions. Pharmacy (Basel). 8:70.

2. Rappo U et al. (2018) Dalbavancin for the Treatment of Osteomyelitis in Adult Patients: A Randomized Clinical Trial of Efficacy and Safety. Open Forum Infect Dis 6:331.