Real-World Use of Dalbavancin in a United States Tertiary Referral Center

TL;DR

The study examines the real-world use of dalbavancin, an antibiotic, in treating various infections, finding it to be safe and effective even for off-label purposes.

Contribution

The study provides new insights into the off-label use of dalbavancin for treating a range of gram-positive infections in complex patient scenarios.

Findings

Dalbavancin was used off-label in 40 out of 52 patients for infections like bloodstream infections and osteomyelitis.

A 67.6% clinical cure rate was observed in patients who completed the treatment.

Mild adverse events were reported, but no discontinuations due to adverse events occurred.

Abstract

Introduction

Outpatient management of serious bacterial infections can be difficult particularly in situations where outpatient parenteral antibiotic therapy may be difficult due to patient-specific factors such as history of medical non-compliance, unstable housing situations, and individuals who use injection drugs. Dalbavancin is a long-acting lipoglycopeptide antibiotic currently approved for the treatment of bacterial skin and soft tissue infections; however, it is often employed in the management of other infections caused by gram-positive organisms. Data regarding the off-label usage of dalbavancin remains an emerging area of study.

Methods

A retrospective cohort study of all 52 inpatients, ages 18-56, who received ≥1 dose of dalbavancin between November 2017 and February 2023 was conducted. Rates of treatment completion and clinical cure were assessed at 42 days post-dalbavancin treatment.

Results

Fifty-two adults were identified. Dalbavancin was used to treat skin/soft tissue infections in 12 patients (23.5%). Off-label uses accommodated for 40 patients, with diagnoses including as follows: bloodstream infection (21, 41.2%), osteomyelitis (12, 23.5%), septic arthritis (10, 13.3%), native valve infective endocarditis (six, 11.8%), prosthetic joint infection (three, 5.9%), epidural abscess (three, 5.9%), catheter-related bloodstream infection (one, 2%), and other infections (13, 25.5%). Among patients who completed therapy, cure, as assessed at day 42, was achieved in 35 (67.6%) patients. Intravenous (IV) drug and the need for facility placement to receive IV antibiotics use were the commonly cited reasons for dalbavancin utilization. Adverse events included mild elevation in serum aminotransferases which occurred in six patients (11.5%) and acute kidney injury which occurred in two (3.8%). There were no adverse events resulting in drug discontinuation.

Conclusions

Dalbavancin use, including off-label indications, such as bacteremia, septic arthritis, osteomyelitis, prosthetic joint infection, and others, appears safe and associated with favorable treatment responses. Therefore, it can be considered as an alternative treatment approach in patients who may not be candidates for traditional outpatient parenteral antimicrobial therapy.