Dalbavancin dosage regimens in the treatment of gram-positive infections: a case series and review of the literature

Background: Dalbavancin is approved by the United States Food and Drug Administration (FDA) for one-dose or two-dose regimens in the treatment of acute bacterial skin and skin structure infections (ABSSSIs). This agent may also be utilized off-label for invasive gram-positive infections, but there are no standard dosage recommendations for off-label use (1). We evaluated different dosage regimens used in real-life experiences. Methods: Medication administration data at ProMedica Health System and The University of Toledo Medical Center was reviewed to identify patients treated with dalbavancin to evaluate the efficacy and safety of common dosing regimens for both invasive and noninvasive gram-positive infections. The primary outcome was treatment failure defined as recurrence or hospitalization due to the same infection within one year. Baseline characteristics between successfully treated and failed groups were compared. Results: Throughout the 5 years (2016-2021), 131 patients who received dalbavancin were enrolled. 82 (63%) of patients had ABSSSIs. Forty-nine (37%) fell under the category of invasive gram-positive infections. Forty-one patients (31%) of them had failure of treatment. Of the patients who failed treatment, twenty-three patients received one dose of intravenous dalbavancin, and eighteen patients received at least two doses of dalbavancin. Adverse events were noticeable for one patient with transient rash on the hand and one patient had non Clostridioides difficile diarrhea. Conclusion: Dalbavancin has been a safe and convenient option for the treatment of gram-positive infections. A regimen of two doses or more of dalbavancin may offer a better outcome than one dose only for both invasive and non-invasive gram-positive infections.