Dalbavancin: a review

Dalbavancin is a second-generation lipoglycopeptide bactericidal agent. Due to its once-weekly intravenous (i.v.) dosing and greater tissue penetration, dalbavancin may offer advantages in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) as compared to vancomycin, the gold standard in the treatment of MRSA. Dalbavancin binds to the terminal D-alanyl-D-alanine moiety of peptidoglycan precursors in bacterial cell walls. Such binding blocks enzymes involved in the final stages of peptidoglycan synthesis and cell wall formation. Dalbavancin exhibits an elimination half-life of approximately 200 hours, allowing it to be dosed weekly. The best-studied dosing schedule for dalbavancin involves the i.v. administration of 1 g of dalbavancin followed by 500 mg one week later. Phase III clinical trials comprising more than 1,500 patients evaluated once-weekly dalbavancin in Gram-positive skin and soft tissue infections (SSTIs). When compared to linezolid, cefazolin or vancomycin, dalbavancin met the primary endpoint of noninferiority at two weeks following therapy. The side-effect profile of dalbavancin is mild, with headache and pyrexia being the most common adverse effects. Dalbavancin is eliminated renally and hepatically, and does not need dose adjustments in patients with renal insufficiency. Once-weekly dosing with dalbavancin gives it another advantage when compared with vancomycin, and may alleviate the need for the continued presence of indwelling catheters in some patients with SSTIs and other infections requiring prolonged doses of antibiotics. While some in vitro evidence supports dalbavancin's effectiveness against vancomycin-resistant S. aureus, the preponderance of in vivo evidence does not demonstrate its effectiveness against vancomycin-resistant S. aureus.