From the Guidelines
Dalbavancin can be used for the treatment of osteomyelitis, discitis, and epidural abscess, particularly for gram-positive infections including methicillin-resistant Staphylococcus aureus (MRSA). The typical dosing regimen for bone and joint infections is 1500 mg IV initially, followed by 1500 mg IV one week later, though some clinicians use a single 1500 mg dose 1. For these deep-seated infections, a longer course may be necessary, with some specialists recommending additional doses of 1500 mg every 2-4 weeks depending on clinical response. Dalbavancin offers advantages including excellent bone penetration, very long half-life (allowing for infrequent dosing), and the ability to complete therapy as an outpatient without daily IV access. This can facilitate earlier hospital discharge and eliminate the need for prolonged daily IV antibiotics. However, treatment decisions should be based on culture results when available, as dalbavancin is only effective against gram-positive organisms.
Some key considerations when using dalbavancin for these infections include:
- The potential for treatment-emergent dalbavancin resistance as well as cross-resistance to daptomycin and vancomycin 1
- The importance of infectious disease consultation for these complex infections
- The potential need for surgical intervention alongside antibiotic therapy, particularly for abscess drainage or debridement of infected bone
- The need to choose an antibiotic regimen based on the likely or proven causative pathogen(s) and their antibiotic susceptibilities, as well as other factors such as clinical severity of the infection and patient-related factors 1
It is also important to note that while dalbavancin may be effective for the treatment of osteomyelitis, discitis, and epidural abscess, the evidence for its use in these infections is not as strong as it is for other infections, such as skin and soft tissue infections. Therefore, treatment decisions should be made on a case-by-case basis, taking into account the individual patient's needs and circumstances.
From the Research
Dalbavancin for Osteomyelitis and Discitis Treatment
- Dalbavancin is a long-acting semi-synthetic lipoglycopeptide that has been licensed for acute bacterial skin and skin structure infections (ABSSSI) caused by susceptible Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci 2.
- Several studies have investigated the use of dalbavancin for the treatment of osteomyelitis, with reported success rates ranging from 44% to 100% 2.
- A case report described the use of multiple weekly dalbavancin infusions for the treatment of vertebral osteomyelitis caused by MRSA, with the patient showing clinical improvement and no apparent adverse events 3.
- A randomized clinical trial found that a 2-dose regimen of dalbavancin was effective and well-tolerated for the treatment of osteomyelitis in adults, with a clinical cure rate of 97% at day 42 4.
Dalbavancin for Epidural Abscess Treatment
- There is limited information available on the use of dalbavancin for the treatment of epidural abscess.
- However, dalbavancin has been shown to be effective against Gram-positive pathogens, which are commonly involved in epidural abscesses 2, 5.
- Further studies are needed to determine the efficacy and safety of dalbavancin for the treatment of epidural abscess.
Safety and Efficacy of Dalbavancin
- Dalbavancin has been shown to be safe and effective in the treatment of osteomyelitis, with a low rate of adverse events 4, 6.
- A multicenter retrospective review found that 90% of patients with osteomyelitis who received dalbavancin achieved clinical success, with no adverse events noted 6.
- However, more studies are needed to validate these findings and to determine the optimal dosing schedule for dalbavancin in the treatment of osteomyelitis and other infections 2, 5.