What is the recommended treatment and dosage of Dalavancin (Dalbavancin) for acute bacterial skin and skin structure infections (ABSSSI)?

Dalbavancin Treatment for Acute Bacterial Skin and Skin Structure Infections (ABSSSI)

For acute bacterial skin and skin structure infections (ABSSSI), dalbavancin is recommended as either a single 1500 mg IV dose or as 1000 mg IV followed by 500 mg IV one week later. 1

Dosing Options

Dalbavancin offers two FDA-approved dosing regimens for ABSSSI:

1. Two-dose regimen: 1000 mg IV on day 1, followed by 500 mg IV on day 8 2, 1
2. Single-dose regimen: 1500 mg IV as a one-time dose 1, 3

Both regimens have demonstrated equivalent efficacy in clinical trials, with the single-dose option providing additional convenience 3.

Efficacy

• Dalbavancin has demonstrated non-inferior efficacy to vancomycin/linezolid in clinical trials for ABSSSI 4
• Clinical success rates of 81.4% for single-dose and 84.2% for two-dose regimens have been observed at 48-72 hours (early clinical response) 3
• Similar clinical outcomes were maintained at day 14 (84.0% vs 84.8%) and day 28 (84.5% vs 85.1%) between single and two-dose regimens 3
• Particularly effective against MRSA infections, with clinical success rates of 92.9% (single-dose) and 95.3% (two-dose) in patients with MRSA at baseline 3

Safety Profile

• Dalbavancin demonstrates a favorable safety profile with lower nephrotoxicity rates compared to vancomycin (3.7% vs 9.3%, p=0.039) 5
• Treatment-emergent adverse events occur in approximately 20% of patients, typically mild to moderate in intensity and transient 4, 3
• No requirement for therapeutic drug monitoring, unlike vancomycin 4

Dose Adjustments

• For patients with severe renal impairment (CrCl < 30 mL/min) not on regular dialysis:
  • Single-dose regimen: Reduce to 1000 mg IV
  • Two-dose regimen: 750 mg IV on day 1, followed by 375 mg IV on day 8 5

Clinical Considerations

• Dalbavancin is particularly valuable for outpatient management of infections that would otherwise require hospitalization 1
• The prolonged half-life and convenient dosing make it suitable for patients who might have difficulty with adherence to daily antibiotic regimens 6
• Excellent skin and soft tissue penetration makes it particularly effective for ABSSSI 6

Alternative Options for MRSA ABSSSI

If dalbavancin is not available, the following IV options are recommended with strong evidence (recommendation 1A) 2:

• Daptomycin (10 mg/kg/dose IV once daily)
• Linezolid IV
• Ceftaroline IV
• Vancomycin IV
• Tigecycline IV
• Tedizolid IV

Treatment Duration

Seven to 14 days of therapy is generally recommended for ABSSSI but should be based on clinical response 2. The advantage of dalbavancin is that the full treatment course is completed with either one or two doses.