dalbavancin
Brand: Dalvance
Prototype: vancomycin
Drug Class: lipoglycopeptide antibiotic
Drug Family: antibiotic
Subclass: long-acting lipoglycopeptide
Organ Systems: infectious-disease
Mechanism of Action
Inhibits gram-positive cell wall synthesis through dual mechanisms: peptidoglycan precursor binding and membrane disruption; semi-synthetic derivative of teicoplanin with a lipophilic tail enabling once-weekly dosing.
D-Ala-D-Ala peptidoglycan precursorsbacterial cell membrane
Indications
- acute bacterial skin and skin structure infections (ABSSSI) due to gram-positive organisms including MRSA
- alternative for osteomyelitis in select patients (off-label)
Contraindications
- dalbavancin hypersensitivity
Adverse Effects
Common
- nausea
- diarrhea
- headache
Serious
- C. difficile colitis
- anaphylaxis
- infusion-related reactions (flushing, urticaria — Red Man Syndrome-like)
Pharmacokinetics (ADME)
| Absorption | IV only |
| Distribution | extensive tissue distribution; high protein binding |
| Metabolism | minimal; hydroxymethyl dalbavancin active metabolite |
| Excretion | renal and fecal (45% in urine, 20% in feces over 42 days) |
| Half-life | 346 hours (~14 days) |
| Onset | immediate (IV) |
| Peak | end of infusion |
| Duration | one-dose or two-dose regimen covers the treatment course |
| Protein Binding | 93% |
| Vd | large |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| other nephrotoxins | additive nephrotoxicity possible | moderate |
Nursing Considerations
- Administer IV over 30 minutes; a one-dose regimen (1500 mg) or two-dose regimen (1000 mg on day 1, 500 mg on day 8) are both FDA-approved.
- Monitor for infusion-related reactions; slow infusion rate or pre-medicate with antihistamines if reaction occurs.
- Unlike oritavancin, dalbavancin does not significantly interfere with coagulation assays.
- Counsel patients on the extended half-life; side effects may persist for weeks after the dose.
Clinical Pearls
- Dalbavancin's 14-day half-life allows either a one-dose or two-dose weekly regimen, offering a compelling outpatient strategy for patients who would otherwise require prolonged inpatient IV antibiotics.
- Both dalbavancin and oritavancin avoid the need for therapeutic drug monitoring, a significant advantage over vancomycin in the outpatient setting.
Safety Profile
Pregnancy use-with-caution
Lactation use-with-caution
Renal Adjustment Required
Hepatic Adjustment Not required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.