Dalbavancin: A Novel Lipoglycopeptide Antibacterial

Scott D. Pope, Pharm.D.; Andrew M. Roecker, Pharm.D.

Disclosures

Pharmacotherapy. 2006;26(7):908-918. 

In This Article

Abstract and Introduction

Dalbavancin is a new lipoglycopeptide antibacterial possessing in vitro activity against a variety of gram-positive pathogens. Against methicillin-susceptible and methicillin-resistant Staphylococcus aureus, it has demonstrated favorable minimum inhibitory concentration ranges compared with those of currently available agents. Dalbavancin is highly protein bound (> 90%), which may contribute to its prolonged half-life of 149–300 hours. Because of this long half-life, once-weekly dosing strategies have been used in clinical trials. Efficacy and tolerability have been demonstrated in a wide variety of animal infection models. Clinical success and safety have been shown in phase II and III trials for skin and soft-tissue infections and a phase II trial for catheter-related bloodstream infections. In these trials with vancomycin, linezolid, and various β-lactams as comparators, comparable results have been reported. The results of further phase III trials are anxiously awaited and will more clearly define the clinical role of this novel agent.

Staphylococcus aureus is a gram-positive organism responsible for a wide variety of invasive infections that cause significant morbidity and mortality.[1–12] Advancing resistance, specifically methicillin-resistant S. aureus (MRSA), has negatively affected patient outcomes[2,3,13] and has resulted in increased use of vancomycin.[14] After many years of sustained activity against MRSA, vancomycin is now experiencing resistance in the form of vancomycin-intermediate S. aureus (VISA)[15–24] and vancomycin-resistant S. aureus (VRSA).[25–27] The occurrence of VRSA was limited to five cases at the time of writing this article[25–28]; however, VRSA may eventually affect empiric antimicrobial choices for staphylococcal infections. Although in vitro susceptibility to trimethoprim-sulfamethoxazole is promising against current VISA and VRSA isolates,[15–27] alternatives for treating invasive infections are needed. In addition to S. aureus resistance, 89.1% of coagulase-negative staphylococcal isolates are methicillin resistant and 28.5% of enterococcal isolates are reportedly vancomycin resistant.[29] Thus, for many gram-positive infections, resistance is a commonly encountered clinical issue. Health care practitioners are in need of more therapeutic choices for treating these resistant infections.

Dalbavancin, a novel lipoglycopeptide, is in phase III trials for treatment of resistant gram-positive organisms. To date, published efficacy and safety data are available for treatment of skin and soft-tissue infections and catheter-related bloodstream infections.

To obtain the data reviewed in this article, we performed a PubMed/MEDLINE electronic database search for English-language articles published from January 1966–September 2005 that contained the keywords dalbavancin, BI 397, or lipoglycopeptide.

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