Dalbavancin is a
lipoglycopeptide antibiotic recently approved by the United States Food and Drug Administration (FDA) for acute bacterial skin and skin structure
infections (ABSSSIs). It is active against gram-positive pathogens, including methicillin-resistant Staphylococcus aureus (MRSA), and minimum inhibitory concentrations (MICs) are consistently <0.125 µg/ml, much lower than most other anti-MRSA agents.
Dalbavancin possesses an extended half-life of over 1 week, allowing an initial dose of 1000 mg followed by 500 mg 1 week later to complete a course of
therapy for ABSSSI. It is approximately 95%
protein bound and is widely distributed throughout the body, achieving concentrations similar to plasma levels in numerous tissues. Against MRSA,
dalbavancin is 4-8 times more potent than
vancomycin in vitro, and limited data suggest it possesses activity against MRSA with reduced susceptibility to
vancomycin such as hVISA and VISA.
Dalbavancin also possesses in vitro activity against streptococci and enterococci, although activity against vancomycin-resistant enterococci is lacking. In phase 3 ABSSSI studies,
dalbavancin demonstrated similar activity to
vancomycin and provides a more convenient dosing regimen. Limited phase 2 data suggest
dalbavancin also possesses activity in
catheter-related
bloodstream infections. Potential further
therapeutic uses include conditions that require long-term treatment such as
osteomyelitis and
infective endocarditis, although data are currently lacking. The extended half-life of
dalbavancin, along with its in vitro activity against gram-positive organisms with reduced susceptibility to other anti-MRSA
antibiotics, suggest it could have an exciting clinical role going forward.