What is Dalvance (dalbavancin)?

Dalvance (Dalbavancin): A Long-Acting Lipoglycopeptide Antibiotic

Dalvance (dalbavancin) is a long-acting lipoglycopeptide antibiotic FDA-approved for the treatment of acute bacterial skin and skin structure infections (ABSSSI) caused by susceptible Gram-positive organisms, including methicillin-resistant Staphylococcus aureus (MRSA).

Mechanism of Action and Antimicrobial Spectrum

Dalbavancin works through two distinct mechanisms:

• Inhibition of bacterial cell wall synthesis
• Cell membrane anchoring mechanism

It demonstrates potent activity against:

• Staphylococcus aureus (including MRSA)
• Coagulase-negative staphylococci
• Streptococcus species (including S. pneumoniae and β-hemolytic streptococci)
• Vancomycin-susceptible Enterococci 1

Notably, dalbavancin is 4-8 times more potent against MRSA than vancomycin in vitro, with minimum inhibitory concentrations (MICs) consistently <0.125 µg/ml 1.

Pharmacokinetic Properties

Dalbavancin has several unique pharmacokinetic characteristics:

• Extremely long half-life of approximately 14 days 2
• High protein binding (93-95%)
• Wide tissue distribution (skin, bone, peritoneal space, epithelial lining fluid)
• Combined renal (45%) and non-renal elimination
• Dose adjustment only needed for patients with creatinine clearance <30 mL/min not on dialysis 3

Dosing Regimen

The FDA-approved dosing regimen for ABSSSI is:

• 1500 mg as a single dose, or
• 1000 mg followed by 500 mg one week later 4

This unique dosing schedule is possible due to dalbavancin's extended half-life, making it the only once-weekly antibiotic option for serious Gram-positive infections.

Clinical Applications

Dalbavancin is primarily indicated for:

• Acute bacterial skin and skin structure infections (ABSSSI) 4

Emerging evidence suggests potential utility in:

• Catheter-related bloodstream infections 5
• Complicated skin and skin structure infections 1

Investigational uses being explored include:

• Osteomyelitis
• Infective endocarditis
• Diabetic foot infections
• Joint infections 5

Safety Profile

Dalbavancin demonstrates a favorable safety profile:

• Overall adverse event rates similar to or lower than comparator antibiotics (44.9% vs 46.8%) 2
• Most common adverse events include nausea, headache, diarrhea, constipation, and vomiting
• No significant drug interactions reported
• No need for therapeutic drug monitoring

Clinical Advantages

The key advantages of dalbavancin include:

• Convenient once-weekly dosing
• Potent activity against MRSA and other Gram-positive pathogens
• No need for daily intravenous access
• Potential for outpatient treatment of serious infections
• Similar efficacy to standard therapies like vancomycin and linezolid 4

Important Considerations

When using dalbavancin, clinicians should be aware that:

• It lacks activity against vancomycin-resistant enterococci 1
• It does not penetrate cerebrospinal fluid adequately 3
• Proper laboratory testing requires specific methodology using dimethyl sulfoxide (DMSO) as a solvent and polysorbate-80 to prevent adherence to plastic 6
• It is not effective against Gram-negative pathogens

Dalbavancin represents an important addition to the antimicrobial armamentarium, particularly for patients requiring prolonged therapy for Gram-positive infections who might benefit from reduced hospital stays or avoiding daily intravenous access.