Dalbavancin

Dalbavancin is a semisynthetic lipoglycopeptide antibiotic used to treat acute bacterial skin and skin-structure infections (ABSSSI) caused by Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). It belongs to the glycopeptide family and is related to vancomycin and teicoplanin in its mechanism of action.

Mechanism and spectrum: Dalbavancin inhibits bacterial cell wall synthesis by binding to the D-Ala-D-Ala terminus of peptidoglycan precursors, preventing cross-linking. The long lipophilic side chain helps anchor the molecule to the bacterial membrane, contributing to its potency and extended half-life. It is active primarily against Gram-positive organisms and has limited activity against Gram-negative bacteria. Resistance can occur with certain enterococci and other organisms in which the target is altered.

Dosing and indications: Dalbavancin is administered by intravenous infusion. The approved regimen for ABSSSI consists of two doses: 1,000 mg on day 1 followed by 500 mg on day 8, given over about 30 minutes. This regimen supports once-weekly dosing and can simplify therapy compared with daily antibiotics. It is approved for adults and for certain pediatric patients with ABSSSI who require systemic therapy. As with other antibiotics, susceptibility of the causative organism should be confirmed when possible.

Pharmacokinetics and safety: Dalbavancin has a long elimination half-life, supporting its infrequent dosing. It is primarily cleared renally, and dosing recommendations exist for renal impairment. Common adverse events include diarrhea, nausea, headache, and infusion-related reactions; hypersensitivity and C‑difficulty infections can occur, as with other glycopeptides. It is categorized as pregnancy category C in the United States. Dalbavancin was developed by Durata Therapeutics and approved by the FDA in 2014; it is marketed in the U.S. under the brand name Dalvance.