Dalbavancin

• Brand names: Dalvance, Xydalba
• Route: Intravenous

Dalbavancin is a semi-synthetic derivative of teicoplanin. Like vancomycin it binds the D-alanyl-D-alanine terminus of cell-wall precursors and blocks cross-linking.

A lipophilic side chain anchors the molecule in the bacterial membrane, increasing potency and giving a terminal half-life of about two weeks.

That half-life means a single dose maintains bactericidal levels for a fortnight.

• Single-dose regimen: 1,500 mg intravenously over 30 minutes.
• Two-dose regimen: 1,000 mg on day 1 followed by 500 mg on day 8.
• The dose is reduced when creatinine clearance is under 30 mL/min and the patient is not on dialysis.
• Off-label longer courses are used for osteomyelitis and endocarditis in people who cannot keep an intravenous line, such as those who inject drugs.

Doses listed are typical adult regimens quoted for reference. The actual dose, route and duration are decided by a clinician for the individual patient.

Dalbavancin was derived from a natural glycopeptide made by a Nonomuraea species and developed by Biosearch Italia, then Vicuron and Pfizer.

Regulatory delays over trial design pushed approval back for years; Durata Therapeutics eventually secured FDA approval in 2014, followed by European approval in 2015.

It was one of the first products approved under the US GAIN Act incentives for new antibiotics.

• Nausea, headache and diarrhoea are the most common complaints.
• Infusion reactions similar to vancomycin flushing if given too quickly.
• Raised liver enzymes; rare hypersensitivity. Because the drug persists for weeks, adverse effects cannot be reversed by stopping it.

• Streptococcal and susceptible enterococcal skin infection.
• Increasingly used off-label for osteomyelitis, prosthetic joint infection and endocarditis where outpatient treatment is a priority.