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Brandariz-Núñez D, Luances-Rodríguez A, Feijoo-Vilanova P, Gutiérrez-Urbón JM, Ramudo-Cela L, Martín-Herranz MI, Margusino-Framiñán L. Dalbavancin as consolidation therapy for infective endocarditis in patients with comorbidity. A real world experience. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2024; 37:334-340. [PMID: 38881525 PMCID: PMC11231482 DOI: 10.37201/req/012.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/10/2024] [Accepted: 06/07/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE Infective endocarditis (IE) is a potentially life-threatening infection, the incidence of which has in creased in recent decades, particularly among elderly patients with comorbidity. The primary objective of this study was to evaluate the effectiveness of dalbavancin in the consolidation therapy of IE in patients with comorbidity six months after the end of treatment (EOT). METHODS An observational and retrospective study was conducted on patients with a Charlson Comorbidity Index (CCI) ≥ 3 who were diagnosed with IE and received consolidation therapy with dalbavancin. RESULTS Forty-eight patients were included, 58.3% were male, mean age of 76.2 years (IQR: 66-88), and a mean age adjusted CCI of 6.5 (IQR: 5-7.5). Definite IE was diagnosed in 77% of cases. The most frequently isolated microorganisms were Staphylococcus aureus (45.8%) followed by Enterococcus spp. (31.3%). Complications of IE were observed in 67.7% of cases, and cardiac surgery was performed in 27% of patients. The primary reason for using dalbavancin was outpatient parenteral antibiotic therapy in 85.4% of cases. The effectiveness at EOT was 93.8%. At six months, six IE-related deaths, four unrelated deaths, and two IE relapses were observed. The effectiveness was 77%. Adverse effects related to DBV were reported in 4.2% of cases, of which 2% were considered serious. CONCLUSIONS Dalbavancin has proven to be an effective alternative as consolidation antibiotherapy for IE in elderly patients with comorbidity. Moreover, a very favorable safety profile with few associated adverse effects has been observed in this population.
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Affiliation(s)
- D Brandariz-Núñez
- David Brandariz-Núñez, Pharmacy Department, Universitary Complex Hospital A Coruña (CHUAC). A Coruña, Spain.
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LoVecchio F, McCarthy MW, Ye X, Henry AD, Doan QV, Lock JL, Riccobene T, Lyles RD, Talan DA. Single Intravenous Dose Dalbavancin Pathway for the Treatment of Acute Bacterial Skin and Skin Structure Infections: Considerations for Emergency Department Implementation and Cost Savings. J Emerg Med 2024; 67:e217-e229. [PMID: 38825531 DOI: 10.1016/j.jemermed.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 01/03/2024] [Accepted: 03/06/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND A pathway for the treatment of acute bacterial skin and skin structure infections (ABSSSI) with a single intravenous (IV) dose of dalbavancin was previously shown to reduce hospital admissions and shorten inpatient length of stay (LOS). OBJECTIVES To describe pathway implementation at the emergency department (ED) and evaluate cost-effectiveness of a single-dose dalbavancin administered to ED patients who would otherwise be hospitalized to receive usual care with multidose IV antibiotics. METHODS The dalbavancin pathway was previously implemented at 11 U.S. EDs (doi:10.1111/acem.14258). Patients with ABSSSI, without an unstable comorbidity or infection complication requiring complex management, were treated with a single dose of dalbavancin. At the emergency physicians' discretion, patients were either discharged and received outpatient follow-up or were hospitalized for continued management. A decision analytic cost-effectiveness model was developed from the U.S. healthcare's perspective to evaluate costs associated with the dalbavancin pathway compared with inpatient usual care. Costs (2021 USD) were modeled over a 14-day horizon and included ED visits, drug costs, inpatient stay, and physician visits. One-way and probabilistic sensitivity analyses examined input parameter uncertainty. RESULTS Driven largely by the per diem inpatient cost and LOS for usual care, the dalbavancin pathway was associated with savings of $5133.20 per patient and $1211.57 per hospitalization day avoided, compared with inpatient usual care. The results remained robust in sensitivity and scenario analyses. CONCLUSION The new single-dose dalbavancin ED pathway for ABSSSI treatment, which was previously implemented at 11 U.S. EDs, offers robust cost savings compared to inpatient usual care.
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Affiliation(s)
- Frank LoVecchio
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| | - Matthew W McCarthy
- Cornell University and New York Presbyterian Hospital, New York, New York
| | | | | | | | | | | | | | - David A Talan
- Ronald Reagan UCLA Medical Center, University of California at Los Angeles, Los Angeles, California
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Volk CF, Hutson PR, Rose WE. Simulated Target Attainment of Multidose Regimens of Dalbavancin for Prolonged Durations of Therapy. Open Forum Infect Dis 2024; 11:ofae315. [PMID: 38938895 PMCID: PMC11210303 DOI: 10.1093/ofid/ofae315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/04/2024] [Indexed: 06/29/2024] Open
Abstract
Background Dalbavancin is a long-acting lipoglycopeptide antibiotic that is increasingly utilized for infections that require prolonged treatment durations despite the lack of Food and Drug Administration approval for these indications. There is no consensus regarding optimal dosing of dalbavancin for these infections and no available pharmacokinetic studies to identify optimal dosing for long-term use. Methods An in silico pharmacokinetic simulation was performed to assess the predicted dalbavancin concentration resulting from commonly utilized dosing regimens, in addition to modified regimens. The primary endpoint evaluated was days of median 24-hour free area under the curve over the minimum inhibitory concentration (AUC/MIC) >27.1, the established PK target. Results A dosing regimen of 1500 mg on day 0 and day 7 resulted in median AUC/breakpoint value above the target for 57 days (lower 95% confidence interval [CI], 37 days). A modified regimen of 1500 mg on day 0 and day 21 resulted in an additional 11 days of median AUC/breakpoint target attainment. The other standard dosing regimen modeled was 1000 mg on day 0, then 500 mg weekly for 5 doses. This regimen achieved the AUC/breakpoint target for 76 days (lower 95% CI, 59 days). This regimen was modified to 1000 mg on day 0, then 500 mg on days 14 and 28, which shortened the median effective treatment duration by 14 days but required 3 fewer doses. Conclusions These simulated results, when combined with the favorable observational data, support the use of commonly reported dalbavancin regimens for prolonged therapy durations. In addition, these pharmacokinetic/pharmacodynamic data support extending the dosing interval beyond the frequently reported weekly regimens, which should be investigated further with a clinical trial.
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Affiliation(s)
- Cecilia F Volk
- Pharmacy Practice and Translational Research Division, School of Pharmacy, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Paul R Hutson
- Pharmacy Practice and Translational Research Division, School of Pharmacy, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Warren E Rose
- Pharmacy Practice and Translational Research Division, School of Pharmacy, University of Wisconsin–Madison, Madison, Wisconsin, USA
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Salinas-Botrán A, Olmos-Blanco C, Fernández de Velasco-Pérez D, Guzmán-Carreras A, Morales-Rosas A, Gómez-Ramírez D. Dalbavancin as consolidation antibiotic treatment in infective endocarditis, cardiac implantable electronic devices infection and bacteremia: Clinical experience of 7 years. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024:S2529-993X(24)00128-X. [PMID: 38763866 DOI: 10.1016/j.eimce.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 02/22/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Dalbavancin (DBV), a novel lipoglycopeptide with activity against Gram-positive bacterial infections, is approved for the treatment of acute bacterial skin and skin structure infections (ABSSSIs). It has linear dose-related pharmacokinetics allowing a prolonged interval between doses. It would be a good option for the treatment of patients with Gram-positive cardiovascular infections. METHODS Retrospective analysis of patients with cardiovascular infection (infective endocarditis, bacteremia, implantable electronic device infection) treated with DBV at Hospital Clínico San Carlos (Madrid) for 7 years (2016-2022). Patients were divided in two study groups: 1) Infective endocarditis (IE), 2) Bacteremia. Epidemiological, clinical, microbiological and therapeutic data were analyzed. RESULTS A total of 25 patients were treated with DBV for cardiovascular infection. IE was the most common indication (68%), followed by bacteremia (32%) with male predominance in both groups (64% vs 62%) and median age of 67,7 and 57,5 years, respectively. 100% of blood cultures were positive to Gram-positive microorganisms (Staphylococcus spp., Streptococcus spp. or Enterococcus spp.) in both study groups. Previously to DBV, all patients received other antibiotic therapy, both in the group of IE (median: 80 days) as in bacteremia (14,8 days). The main reason for the administration of DBV was to continue intravenous antimicrobial therapy outside the hospital in both the EI group (n = 15) and the bacteremia group (n = 8). DBV was used as consolidation therapy in a once- or twice-weekly regimen. Microbiological and clinical successes were reached in 84% of cases (n = 21), 76,4% in IE group and 100% in bacteremia group. No patient documented adverse effects during long-term dalbavancin treatment. CONCLUSION DBV is an effective and safety treatment as consolidation antibiotic therapy in IE and bacteremia produced by Gram-positive microorganisms.
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Affiliation(s)
- Alejandro Salinas-Botrán
- Servicio de Medicina Interna, Hospital Clínico San Carlos, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain.
| | - Carmen Olmos-Blanco
- Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | | | | | | | - Daniel Gómez-Ramírez
- Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
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Yeary J, Hacker L, Liang SY. Managing Antimicrobial Resistance in the Emergency Department. Emerg Med Clin North Am 2024; 42:461-483. [PMID: 38641399 DOI: 10.1016/j.emc.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
(Basic awareness and understanding of antimicrobial resistance and prevailing mechanisms can aid emergency physicians in providing appropriate care to patients with infections due to a multidrug-resistant organism (MDRO). Empiric treatment of MDRO infections should be approached with caution and guided by the most likely pathogens based on differential diagnosis, severity of the illness, suspected source of infection, patient-specific factors, and local antibiotic susceptibility patterns. Newer broad-spectrum antibiotics should be reserved for critically ill patients where there is a high likelihood of infection with an MDRO.).
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Affiliation(s)
- Julianne Yeary
- Department of Pharmacy, Barnes Jewish Hospital, 1 Barnes Jewish Place, St Louis, MO 63110, USA.
| | - Larissa Hacker
- Department of Pharmacy, UW Health, 600 Highland Avenue, Madison, WI 53792, USA
| | - Stephen Y Liang
- Department of Emergency Medicine and Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
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Tebano G, Zaghi I, Baldasso F, Calgarini C, Capozzi R, Salvadori C, Cricca M, Cristini F. Antibiotic Resistance to Molecules Commonly Prescribed for the Treatment of Antibiotic-Resistant Gram-Positive Pathogens: What Is Relevant for the Clinician? Pathogens 2024; 13:88. [PMID: 38276161 PMCID: PMC10819222 DOI: 10.3390/pathogens13010088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
Antibiotic resistance in Gram-positive pathogens is a relevant concern, particularly in the hospital setting. Several antibiotics are now available to treat these drug-resistant pathogens, such as daptomycin, dalbavancin, linezolid, tedizolid, ceftaroline, ceftobiprole, and fosfomycin. However, antibiotic resistance can also affect these newer molecules. Overall, this is not a frequent phenomenon, but it is a growing concern in some settings and can compromise the effectiveness of these molecules, leaving few therapeutic options. We reviewed the available evidence about the epidemiology of antibiotic resistance to these antibiotics and the main molecular mechanisms of resistance, particularly methicillin-resistant Sthaphylococcus aureus, methicillin-resistant coagulase-negative staphylococci, vancomycin-resistant Enterococcus faecium, and penicillin-resistant Streptococcus pneumoniae. We discussed the interpretation of susceptibility tests when minimum inhibitory concentrations are not available. We focused on the risk of the emergence of resistance during treatment, particularly for daptomycin and fosfomycin, and we discussed the strategies that can be implemented to reduce this phenomenon, which can lead to clinical failure despite appropriate antibiotic treatment. The judicious use of antibiotics, epidemiological surveillance, and infection control measures is essential to preserving the efficacy of these drugs.
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Affiliation(s)
- Gianpiero Tebano
- Infectious Diseases Unit, AUSL Romagna, Ravenna Hospital, 48121 Ravenna, Italy; (I.Z.); (C.C.); (C.S.)
| | - Irene Zaghi
- Infectious Diseases Unit, AUSL Romagna, Ravenna Hospital, 48121 Ravenna, Italy; (I.Z.); (C.C.); (C.S.)
- Unit of Microbiology, The Greater Romagna Area Hub Laboratory, 47522 Cesena, Italy;
| | - Francesco Baldasso
- Infectious Diseases Unit, AUSL Romagna, Forlì and Cesena Hospitals, 47121 Forlì and Cesena, Italy; (F.B.); (R.C.); (F.C.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
| | - Chiara Calgarini
- Infectious Diseases Unit, AUSL Romagna, Ravenna Hospital, 48121 Ravenna, Italy; (I.Z.); (C.C.); (C.S.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
| | - Roberta Capozzi
- Infectious Diseases Unit, AUSL Romagna, Forlì and Cesena Hospitals, 47121 Forlì and Cesena, Italy; (F.B.); (R.C.); (F.C.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
| | - Caterina Salvadori
- Infectious Diseases Unit, AUSL Romagna, Ravenna Hospital, 48121 Ravenna, Italy; (I.Z.); (C.C.); (C.S.)
| | - Monica Cricca
- Unit of Microbiology, The Greater Romagna Area Hub Laboratory, 47522 Cesena, Italy;
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
| | - Francesco Cristini
- Infectious Diseases Unit, AUSL Romagna, Forlì and Cesena Hospitals, 47121 Forlì and Cesena, Italy; (F.B.); (R.C.); (F.C.)
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Caselli D, Mariani M, Colomba C, Ferrecchi C, Cafagno C, Trotta D, Carloni I, Dibello D, Castagnola E, Aricò M. Real-World Use of Dalbavancin for Treatment of Soft Tissue and Bone Infection in Children: Safe, Effective and Hospital-Time Sparing. CHILDREN (BASEL, SWITZERLAND) 2024; 11:78. [PMID: 38255391 PMCID: PMC10814822 DOI: 10.3390/children11010078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024]
Abstract
Acute bacterial skin and skin structure infections (ABSSSI) and osteoarticular infections compound the burden of morbidity, mortality and prolonged hospitalizations among gram-positive infections. Dalbavancin, a second-generation, intravenous lipoglycopeptide, due to its prolonged half-life, can be a valuable alternative in their treatment when administered as inpatient treatment at the price of an extended hospital stay. Between October 2019 and September 2023, 31 children and adolescents were treated with dalbavancin because of bone and joint infections (n = 12 patients, 39%), ABSSSI (n = 13 patients, 42%), mainly for the limbs, facial cellulitis or complicated ABSSSI (n = 6 patients, 19%), at five Italian pediatric centers. Microbiological study provided gram-positive bacterial isolate in 16 cases, in 11 cases from a positive blood culture; 9 of them were MRSA. Twenty-five patients were initially treated with a different antibiotic therapy: beta-lactam-based in 18 patients (58%), glycopeptide-based in 15 patients (48%) and daptomycin in 6 (19%). The median time that elapsed between admission and start of dalbavancin was 18 days. A total of 61 doses of dalbavancin were administered to the 31 patients: 16 received a single dose while the remaining 15 patients received between two (n = 9) and nine doses. The frequency of administration was weekly in five cases or fortnightly in nine patients. Median length of stay in hospital was 16 days. Median time to discharge after the first dose of dalbavancin was 1 day. Treatment was very well-tolerated: of the 61 administered doses, only four doses, administered to four patients, were associated with an adverse event: drug extravasation during intravenous administration occurred in two patients, with no sequelae; however, in two patients the first administration was stopped soon after infusion start: in one (ID #11), due to headache and vomiting; in another (ID #12) due to a systemic reaction. In both patients, drug infusion was not repeated. None of the remaining 29 patients reported treatment failure (resistant or recurrent disease) or an adverse effect during a median follow-up time of two months. The use of dalbavancin was safe, feasible and also effective in shortening the hospital stay in children and adolescents.
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Affiliation(s)
- Désirée Caselli
- Infectious Diseases, Children’s Hospital Giovanni XXIII, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, 70124 Bari, Italy; (D.C.); (C.C.)
| | - Marcello Mariani
- Pediatrics and Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Claudia Colomba
- Department of Health Promotion, Maternal and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90133 Palermo, Italy;
- Division of Pediatric Infectious Diseases, “G. Di Cristina” Hospital, ARNAS Civico Di Cristina Benfratelli, 90127 Palermo, Italy
| | - Chiara Ferrecchi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Sciences (DINOGMI), University of Genoa, 16126 Genoa, Italy;
| | - Claudio Cafagno
- Infectious Diseases, Children’s Hospital Giovanni XXIII, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, 70124 Bari, Italy; (D.C.); (C.C.)
| | - Daniela Trotta
- Pediatrics, S. Spirito Hospital, A.S.L. Pescara, 65124 Pescara, Italy; (D.T.); (M.A.)
| | - Ines Carloni
- Department of Mother and Child Health, Salesi Children’s Hospital, 60123 Ancona, Italy;
| | - Daniela Dibello
- Pediatric Orthopedics and Traumatology, Children’s Hospital Giovanni XXIII, 70125 Bari, Italy;
| | - Elio Castagnola
- Pediatrics and Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Maurizio Aricò
- Pediatrics, S. Spirito Hospital, A.S.L. Pescara, 65124 Pescara, Italy; (D.T.); (M.A.)
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Carbonara S. The efficacy of dalbavancin and impact on hospitalization and treatment costs in patients with ABSSSI. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2024; 11:13-17. [PMID: 39100524 PMCID: PMC11292618 DOI: 10.33393/grhta.2024.3045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/29/2024] [Indexed: 08/06/2024] Open
Abstract
Acute bacterial skin and skin structure infections (ABSSSIs) represent a common and costly healthcare burden, accounting for millions of annual infections and billions of dollars in healthcare expenditures. Dalbavancin is a long-acting glycopeptide antibiotic that has demonstrated efficacy and safety in the treatment of ABSSSIs. This review article will examine the efficacy of dalbavancin and focus on its impact on the hospital length of stay and costs associated with management of these infections.
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Affiliation(s)
- Sergio Carbonara
- Unità Operativa Complessa di Malattie Infettive, Ospedale Vittorio Emanuele II, Bisceglie - Italy
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Gallerani A, Gatti M, Bedini A, Casolari S, Orlando G, Puzzolante C, Franceschini E, Menozzi M, Santoro A, Barp N, Volpi S, Soffritti A, Pea F, Mussini C, Meschiari M. Long-Term Suppressive Therapeutic-Drug-Monitoring-Guided Dalbavancin Therapy for Cardiovascular Prosthetic Infections. Antibiotics (Basel) 2023; 12:1639. [PMID: 37998841 PMCID: PMC10669433 DOI: 10.3390/antibiotics12111639] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023] Open
Abstract
Dalbavancin represents a promising treatment for cardiovascular prosthetic infections due to its prolonged half-life, bactericidal activity, large spectrum of activity, and excellent biofilm penetration. However, the use of dalbavancin in this setting is limited, and only a few cases have performed therapeutic drug monitoring (TDM) analysis to optimize dosage in suppressive treatments longer than 4 weeks. Our retrospective case series reports the use of dalbavancin in a small cohort of patients with cardiovascular prosthetic infections (cardiac implantable electronic device infections (CEDIs), prosthetic valve endocarditis (PVE), prosthetic vascular graft infections (PVGIs)) treated with dalbavancin as sequential therapy. From May 2019 to May 2023, 14 patients were included: eight cases of PVE (57.1%), seven cases of PVGI (50%), three cases of CEDI (21.4%), and four cases with overlap of infection sites (28.6%). The main pathogen was Staphylococcus aureus (35.7%). Prosthesis replacement was obtained in four patients (28.6%). The median time between symptom onset and the end of treatment was 15 weeks (IQR 7-53), with a median duration of dalbavancin therapy of 8 weeks (IQR 1 to 45 weeks) and 3.5 doses per patient. Among patients managed with TDM-guided strategy, dalbavancin infusion intervals ranged from 4 to 9 weeks. The median length of follow-up was 65 weeks (IQR 23 to 144 weeks). Clinical success was achieved in 10 cases (76.9%); all clinical failures occurred in patients with the implant retained. Among patients monitored by TDM, clinical success was 87.5% vs. 60% in patients treated without TDM. Because of pharmacokinetic individual variability, dalbavancin TDM-guided administration could improve clinical outcomes by individualizing dosing and selecting dosing intervals. This case series seems to suggest a promising role of long-term suppressive dalbavancin treatment for difficult-to-treat cardiovascular prosthesis infection, also with limited surgical indications.
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Affiliation(s)
- Altea Gallerani
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy; (A.B.); (S.C.); (A.S.); (N.B.); (A.S.)
| | - Milo Gatti
- Clinical Pharmacology Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy; (M.G.); (F.P.)
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Andrea Bedini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy; (A.B.); (S.C.); (A.S.); (N.B.); (A.S.)
| | - Stefania Casolari
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy; (A.B.); (S.C.); (A.S.); (N.B.); (A.S.)
| | - Gabriella Orlando
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy; (A.B.); (S.C.); (A.S.); (N.B.); (A.S.)
| | - Cinzia Puzzolante
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy; (A.B.); (S.C.); (A.S.); (N.B.); (A.S.)
| | - Erica Franceschini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy; (A.B.); (S.C.); (A.S.); (N.B.); (A.S.)
| | - Marianna Menozzi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy; (A.B.); (S.C.); (A.S.); (N.B.); (A.S.)
| | - Antonella Santoro
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy; (A.B.); (S.C.); (A.S.); (N.B.); (A.S.)
| | - Nicole Barp
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy; (A.B.); (S.C.); (A.S.); (N.B.); (A.S.)
| | - Sara Volpi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy; (A.B.); (S.C.); (A.S.); (N.B.); (A.S.)
| | - Alessandra Soffritti
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy; (A.B.); (S.C.); (A.S.); (N.B.); (A.S.)
| | - Federico Pea
- Clinical Pharmacology Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy; (M.G.); (F.P.)
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Cristina Mussini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy; (A.B.); (S.C.); (A.S.); (N.B.); (A.S.)
| | - Marianna Meschiari
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy; (A.B.); (S.C.); (A.S.); (N.B.); (A.S.)
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Doernberg SB, Arias CA, Altman DR, Babiker A, Boucher HW, Creech CB, Cosgrove SE, Evans SR, Fowler VG, Fritz SA, Hamasaki T, Kelly BJ, Leal SM, Liu C, Lodise TP, Miller LG, Munita JM, Murray BE, Pettigrew MM, Ruffin F, Scheetz MH, Shopsin B, Tran TT, Turner NA, Williams DJ, Zaharoff S, Holland TL. Priorities and Progress in Gram-positive Bacterial Infection Research by the Antibacterial Resistance Leadership Group: A Narrative Review. Clin Infect Dis 2023; 77:S295-S304. [PMID: 37843115 PMCID: PMC10578051 DOI: 10.1093/cid/ciad565] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
The Antibacterial Resistance Leadership Group (ARLG) has prioritized infections caused by gram-positive bacteria as one of its core areas of emphasis. The ARLG Gram-positive Committee has focused on studies responding to 3 main identified research priorities: (1) investigation of strategies or therapies for infections predominantly caused by gram-positive bacteria, (2) evaluation of the efficacy of novel agents for infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci, and (3) optimization of dosing and duration of antimicrobial agents for gram-positive infections. Herein, we summarize ARLG accomplishments in gram-positive bacterial infection research, including studies aiming to (1) inform optimal vancomycin dosing, (2) determine the role of dalbavancin in MRSA bloodstream infection, (3) characterize enterococcal bloodstream infections, (4) demonstrate the benefits of short-course therapy for pediatric community-acquired pneumonia, (5) develop quality of life measures for use in clinical trials, and (6) advance understanding of the microbiome. Future studies will incorporate innovative methodologies with a focus on interventional clinical trials that have the potential to change clinical practice for difficult-to-treat infections, such as MRSA bloodstream infections.
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Affiliation(s)
- Sarah B Doernberg
- Division of Infectious Diseases, Department of Medicine, University of California, SanFrancisco, California, USA
| | - Cesar A Arias
- Division of Infectious Diseases, Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA
- Center for Infectious Diseases, Houston Methodist Research Institute, Houston, Texas, USA
- Department of Medicine, Weill-Cornell Medical College, New York, New York, USA
| | - Deena R Altman
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Genetics and Genomics Sciences, Icahn School of Medicine at Mount Sinai, NewYork, New York, USA
| | - Ahmed Babiker
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Helen W Boucher
- Tufts University School of Medicine, Medford, Massachusetts, USA
| | - C Buddy Creech
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Vanderbilt Vaccine Research Program, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sara E Cosgrove
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Scott R Evans
- Department of Biostatistics, George Washington University, Washington, District of Columbia, USA
| | - Vance G Fowler
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Stephanie A Fritz
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Toshimitsu Hamasaki
- Biostatistics Center, George Washington University, Rockville, Maryland, USA
| | - Brendan J Kelly
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sixto M Leal
- Department of Laboratory Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Catherine Liu
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Thomas P Lodise
- Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, New York, USA
| | - Loren G Miller
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Division of Infectious Diseases, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Jose M Munita
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clinica Alemana, Universidad del Desarrollo, Santiago, Chile
- Multidisciplinary Initiative for Collaborative Research on Bacterial Resistance, Santiago, Chile
| | - Barbara E Murray
- Division of Infectious Diseases, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Melinda M Pettigrew
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Felicia Ruffin
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Marc H Scheetz
- Pharmacometrics Center of Excellence, College of Pharmacy, Midwestern University, Downers Grove, Illinois, USA
| | - Bo Shopsin
- Division of Infectious Diseases, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
- Department of Microbiology, NewYork University Grossman School of Medicine, New York, New York, USA
| | - Truc T Tran
- Center for Infectious Diseases, Houston Methodist Research Institute, Houston, Texas, USA
| | - Nicholas A Turner
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Derek J Williams
- Division of Hospital Medicine, Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell Jr Children's Hospital at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Smitha Zaharoff
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Thomas L Holland
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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11
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Courjon J, Senneville E, Illes HG, Pavese P, Boutoille D, Daoud FC, Dunkel N, Tattevin P. Effectiveness and safety of dalbavancin in France: a prospective, multicentre cohort study. Int J Antimicrob Agents 2023; 62:106945. [PMID: 37543122 DOI: 10.1016/j.ijantimicag.2023.106945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 07/04/2023] [Accepted: 08/01/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVES Dalbavancin is a lipoglycopeptide antibiotic approved for the treatment of acute bacterial skin and skin structure infections. However, several studies have suggested that it is used mostly for off-label indications. We aimed to describe the use of dalbavancin in patients who received at least one dose of the antibiotic in France. METHODS Prospective, observational, multicentre study conducted in France from September 2018 to April 2020. The primary outcome was the clinical response at 30 days after the last dalbavancin dose. RESULTS A total of 151 patients in 16 centres were included in this study. The main infection sites were bone and joint infections (55.0%), multisite infections (15.9%), and vascular infections (14.6%), and the primary pathogens were coagulase-negative staphylococci (N = 82), Staphylococcus aureus (N = 51), and enterococci (N = 27). Most patients (71.5%) received three previous antibiotic treatments. The number of dalbavancin injections per patient was 1 in 26 patients (17.2%), 2 in 95 patients (62.9%), 3 in 17 patients (11.3%), and more than 3 in 13 patients (8.6%), with a mean cumulative dose of 3089 ± 1461 mg per patient. Among the 129 patients with a complete follow-up, clinical success was achieved in 119 patients (92.2%). At least 1 adverse event was reported in 67 patients (44.4%), including 12 (7.9%) patients with dalbavancin-related adverse events. CONCLUSIONS The results of the study showed that dalbavancin is used mostly for off-label indications and in heavily pretreated patients in France. The clinical response at 30 days after the last dose was favourable in most patients, with a good safety profile.
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Affiliation(s)
- Johan Courjon
- Université Côte d'Azur, CHU Nice, Nice, France, Infectious Disease Unit, Nice, France.
| | - Eric Senneville
- Infectious Diseases Department, Gustave Dron Hospital, Tourcoing, France
| | | | - Patricia Pavese
- Infectious Diseases Department, Grenoble Alpes University Hospital, La Tronche, France
| | - David Boutoille
- Department of Infectious Disease and CIC-UIC 1413 INSERM, Nantes University Hospital, Nantes, France
| | | | | | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
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12
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Dimopoulou D, Mantadakis E, Koutserimpas C, Samonis G. A Narrative Review on the Role of Dalbavancin in the Treatment of Bone and Joint Infections. Antibiotics (Basel) 2023; 12:1492. [PMID: 37887193 PMCID: PMC10604335 DOI: 10.3390/antibiotics12101492] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023] Open
Abstract
Bone and joint infections (BJI) require prolonged antimicrobial treatment, leading to lengthy hospitalizations, high costs, the risk of nosocomial infections, and the development of antimicrobial resistance. Dalbavancin is a novel semisynthetic lipoglycopeptide approved for the treatment of adults and children with acute bacterial skin and skin structure infections. This narrative review aims to summarize the characteristics of dalbavancin and the current scientific evidence regarding its clinical efficacy and safety in the treatment of BJI. A literature search until June 2023 was performed to identify all published research about the role of dalbavancin in the management of BJI. Due to its unique pharmacokinetics characterized by prolonged half-life, high bactericidal activity against most Gram-positive bacteria, a good safety profile, and high tissue penetration, dalbavancin can be a valuable alternative to the treatment of BJI. Clinical studies have shown its non-inferiority compared to conventional therapies in BJI, offering potent activity against key pathogens and an extended dosing interval that may shorten hospitalization. In conclusion, dalbavancin represents a promising treatment option for BJI with a favorable safety profile, but further research in both adults and particularly children, who are ideal candidates for long-acting antibiotics, is necessary to evaluate the role of dalbavancin in BJI.
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Affiliation(s)
- Dimitra Dimopoulou
- Second Department of Pediatrics, “Aghia Sophia” Children’s Hospital, 115 27 Athens, Greece;
| | - Elpis Mantadakis
- Department of Pediatrics, University General Hospital of Alexandroupolis, 681 00 Alexandroupolis, Greece;
| | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, 115 25 Athens, Greece;
| | - George Samonis
- Department of Medicine, University of Crete, 715 00 Heraklion, Greece
- First Department of Medical Oncology, “Metropolitan” Hospital, 185 47 Attica, Greece
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13
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Carcione D, Intra J, Andriani L, Campanile F, Gona F, Carletti S, Mancini N, Brigante G, Cattaneo D, Baldelli S, Chisari M, Piccirilli A, Di Bella S, Principe L. New Antimicrobials for Gram-Positive Sustained Infections: A Comprehensive Guide for Clinicians. Pharmaceuticals (Basel) 2023; 16:1304. [PMID: 37765112 PMCID: PMC10536666 DOI: 10.3390/ph16091304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/30/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Antibiotic resistance is a public health problem with increasingly alarming data being reported. Gram-positive bacteria are among the protagonists of severe nosocomial and community infections. The objective of this review is to conduct an extensive examination of emerging treatments for Gram-positive infections including ceftobiprole, ceftaroline, dalbavancin, oritavancin, omadacycline, tedizolid, and delafloxacin. From a methodological standpoint, a comprehensive analysis on clinical trials, molecular structure, mechanism of action, microbiological targeting, clinical use, pharmacokinetic/pharmacodynamic features, and potential for therapeutic drug monitoring will be addressed. Each antibiotic paragraph is divided into specialized microbiological, clinical, and pharmacological sections, including detailed and appropriate tables. A better understanding of the latest promising advances in the field of therapeutic options could lead to the development of a better approach in managing antimicrobial therapy for multidrug-resistant Gram-positive pathogens, which increasingly needs to be better stratified and targeted.
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Affiliation(s)
- Davide Carcione
- Laboratory of Medicine and Microbiology, Busto Arsizio Hospital—ASST Valle Olona, 21052 Busto Arsizio, VA, Italy; (D.C.); (G.B.)
| | - Jari Intra
- Clinical Chemistry Laboratory, Fondazione IRCCS San Gerardo Dei Tintori, 20900 Monza, MB, Italy;
| | - Lilia Andriani
- Clinical Pathology and Microbiology Unit, Hospital of Sondrio, 23100 Sondrio, Italy;
| | - Floriana Campanile
- Department of Biomedical and Biotechnological Sciences, Section of Microbiology, University of Catania, 95123 Catania, Italy;
| | - Floriana Gona
- Laboratory of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (F.G.); (S.C.)
| | - Silvia Carletti
- Laboratory of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (F.G.); (S.C.)
| | - Nicasio Mancini
- Laboratory of Medical Microbiology and Virology, Department of Medicine and Technological Innovation, University of Insubria, 21100 Varese, Italy;
- Laboratory of Medical Microbiology and Virology, Fondazione Macchi University Hospital, 21100 Varese, Italy
| | - Gioconda Brigante
- Laboratory of Medicine and Microbiology, Busto Arsizio Hospital—ASST Valle Olona, 21052 Busto Arsizio, VA, Italy; (D.C.); (G.B.)
| | - Dario Cattaneo
- Department of Infectious Diseases ASST Fatebenefratelli Sacco, 20157 Milan, Italy;
| | - Sara Baldelli
- Pharmacology Laboratory, Clinical Chemistry Laboratory, Diagnostic Department, ASST Spedali Civili, 25123 Brescia, Italy;
| | - Mattia Chisari
- Microbiology and Virology Unit, Great Metropolitan Hospital “Bianchi-Melacrino-Morelli”, 89100 Reggio Calabria, Italy;
| | - Alessandra Piccirilli
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Stefano Di Bella
- Clinical Department of Medical, Surgical, and Health Sciences, Trieste University, 34129 Trieste, Italy;
| | - Luigi Principe
- Microbiology and Virology Unit, Great Metropolitan Hospital “Bianchi-Melacrino-Morelli”, 89100 Reggio Calabria, Italy;
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14
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Borgonovo F, Quici M, Gidaro A, Giustivi D, Cattaneo D, Gervasoni C, Calloni M, Martini E, La Cava L, Antinori S, Cogliati C, Gori A, Foschi A. Physicochemical Characteristics of Antimicrobials and Practical Recommendations for Intravenous Administration: A Systematic Review. Antibiotics (Basel) 2023; 12:1338. [PMID: 37627758 PMCID: PMC10451375 DOI: 10.3390/antibiotics12081338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
Most antimicrobial drugs need an intravenous (IV) administration to achieve maximum efficacy against target pathogens. IV administration is related to complications, such as tissue infiltration and thrombo-phlebitis. This systematic review aims to provide practical recommendations about diluent, pH, osmolarity, dosage, infusion rate, vesicant properties, and phlebitis rate of the most commonly used antimicrobial drugs evaluated in randomized controlled studies (RCT) till 31 March 2023. The authors searched for available IV antimicrobial drugs in RCT in PUBMED EMBASE®, EBSCO® CINAHL®, and the Cochrane Controlled Clinical trials. Drugs' chemical features were searched online, in drug data sheets, and in scientific papers, establishing that the drugs with a pH of <5 or >9, osmolarity >600 mOsm/L, high incidence of phlebitis reported in the literature, and vesicant drugs need the adoption of utmost caution during administration. We evaluated 931 papers; 232 studies were included. A total of 82 antimicrobials were identified. Regarding antibiotics, 37 reach the "caution" criterion, as well as seven antivirals, 10 antifungals, and three antiprotozoals. In this subgroup of antimicrobials, the correct vascular access device (VAD) selection is essential to avoid complications due to the administration through a peripheral vein. Knowing the physicochemical characteristics of antimicrobials is crucial to improve the patient's safety significantly, thus avoiding administration errors and local side effects.
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Affiliation(s)
- Fabio Borgonovo
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
| | - Massimiliano Quici
- Internal Medicine Unit, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Antonio Gidaro
- Internal Medicine Unit, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Davide Giustivi
- Emergency Department and Vascular Access Team ASST Lodi, 26900 Lodi, Italy
| | - Dario Cattaneo
- Unit of Clinical Pharmacology, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
| | - Cristina Gervasoni
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
| | - Maria Calloni
- Internal Medicine Unit, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Elena Martini
- Internal Medicine Unit, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Leyla La Cava
- Internal Medicine Unit, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Spinello Antinori
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
| | - Chiara Cogliati
- Internal Medicine Unit, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Andrea Gori
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
| | - Antonella Foschi
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
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15
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Ruiz-Sancho A, Núñez-Núñez M, Castelo-Corral L, Martínez-Marcos FJ, Lois-Martínez N, Abdul-Aziz MH, Vinuesa-García D. Dalbavancin as suppressive antibiotic therapy in patients with prosthetic infections: efficacy and safety. Front Pharmacol 2023; 14:1185602. [PMID: 37448966 PMCID: PMC10337584 DOI: 10.3389/fphar.2023.1185602] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023] Open
Abstract
Suppressive antibiotic therapy (SAT) is a strategy to alleviate symptoms and/or to reduce the progression of an infection when other treatment options cannot be used. Dalbavancin, due to its prolonged half-life, enables (bi) weekly dosing. Here, we report our multicenter real-life clinical experience with dalbavancin used as SAT in patients with prosthetic joint or vascular infections. Medical records of all adult patients with documented vascular or orthopedic chronic prosthetic infections, who received dalbavancin as SAT between 2016 and 2018 from four Spanish hospitals were reviewed for inclusion. Descriptive analysis of demographic characteristics, Charlson Comorbidity index, Barthel index, isolated pathogens and indication, concomitant antibiotic use, adverse events, and clinical outcome of SAT were performed. Eight patients were eligible for inclusion, where six patients had prosthetic vascular infections (aortic valve) and two patients had knee prosthetic joint infections. The most common pathogens were methicillin-susceptible Staphylococcus aureus and Enterococcus faecium. All patients had a history of prior antibiotic treatment for the prosthetic infection [median duration of antibiotic days 125 days (IQR, 28-203 days)]. The median number of dalbavancin doses was 29 (IQR, 9-61) and concomitant antibiotic use (n = 5, 62.5%). Clinical success was reported in 75% (n = 6) of patients. Adverse events were reported in two patients (mild renal and hepatic impairment). The median estimated cost savings due to the avoided hospital days was €60185 (IQR, 19,916-94984) per patient. Despite the limitations of our study, this preliminary data provides valuable insight to support further evaluation of dalbavancin for SAT in patients with prosthetic infections in the outpatient setting when alternative treatments are not feasible.
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Affiliation(s)
- Andrés Ruiz-Sancho
- Infectious Diseases Department, University Hospital Clinico San Cecilio, Granada, Spain
- Biosanitary Research Institute, Ibs Granada, Granada, Spain
| | - María Núñez-Núñez
- Biosanitary Research Institute, Ibs Granada, Granada, Spain
- Pharmacy Department, University Hospital Clinico San Cecilio, Granada, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Laura Castelo-Corral
- Infectious Diseases Department, University Hospital Complexo A Coruña, A Coruña, Spain
| | | | | | - Mohd Hafiz Abdul-Aziz
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - David Vinuesa-García
- Infectious Diseases Department, University Hospital Clinico San Cecilio, Granada, Spain
- Biosanitary Research Institute, Ibs Granada, Granada, Spain
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16
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Riccobene T, Lock J, Lyles RD, Georgiades B, Nowak M, Gonzalez PL, Park J, Rappo U. Dalbavancin for the Treatment of Acute Bacterial Skin and Skin Structure Infection in Patients With Obesity or Diabetes: A Subgroup Analysis of Pooled Phase 3 Clinical Trials. Open Forum Infect Dis 2023; 10:ofad256. [PMID: 37305839 PMCID: PMC10249272 DOI: 10.1093/ofid/ofad256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 05/08/2023] [Indexed: 06/13/2023] Open
Abstract
Background We assessed the efficacy and safety of dalbavancin, a long-acting lipoglycopeptide with activity against Gram-positive pathogens, for treatment of acute bacterial skin and skin structure infections (ABSSSI) in patients with high body mass index (BMI) and/or diabetes. Methods Data from two phase 3 trials of dalbavancin (1000 mg intravenous [IV], day 1; 500 mg IV, day 8) versus comparator and one phase 3b trial of single-dose (1500 mg IV, day 1) versus 2-dose (1000 mg IV, day 1; 500 mg IV, day 8) dalbavancin in adults with ABSSSI were pooled and summarized separately by baseline BMI and diabetes status. Clinical success at 48 to 72 hours (≥20% reduction in lesion size), end of treatment ([EOT] day 14), and day 28 was evaluated in the intent-to-treat (ITT) and microbiological ITT (microITT) populations. Safety data were reported in patients who received ≥1 dose of study drug. Results In the dalbavancin ITT population (BMI, n = 2001; diabetes, n = 2010), at 48 to 72 hours (and EOT) clinical success was achieved in 89.3% (EOT, 90.9%) of patients with normal BMI and 78.9% to 87.6% (EOT, 91.0% to 95.2%) of patients with elevated BMI. Clinical success after dalbavancin treatment was achieved in 82.4% (EOT, 90.8%) of patients with diabetes and 86.0% (EOT, 91.6%) of patients without diabetes. Similar trends were observed for infections due to methicillin-resistant Staphylococcus aureus or methicillin-susceptible S aureus (microITT population). Conclusions Dalbavancin is effective, with sustained clinical success rates in patients with obesity or diabetes, with a similar safety profile across patient groups.
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Affiliation(s)
- Todd Riccobene
- Correspondence: Jenny Park, PharmD, AbbVie Inc., 5 Giralda Farms, Madison, NJ 07940 (); Todd Riccobene, PhD, Anti-Infectives and Infectious Diseases, US Medical Affairs, Research and Development, AbbVie Inc., 5 Giralda Farms, Madison, NJ 07940 ()
| | - John Lock
- AbbVie Inc., Madison, New Jersey, USA
| | | | | | - Michael Nowak
- Present Affiliation: Spero Therapeutics, Cambridge, MA, USA
| | | | - Jenny Park
- Correspondence: Jenny Park, PharmD, AbbVie Inc., 5 Giralda Farms, Madison, NJ 07940 (); Todd Riccobene, PhD, Anti-Infectives and Infectious Diseases, US Medical Affairs, Research and Development, AbbVie Inc., 5 Giralda Farms, Madison, NJ 07940 ()
| | - Urania Rappo
- Present Affiliation: BiomX Inc., Cambridge, MA, USA
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17
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Volpicelli L, Venditti M, Oliva A. Acute bacterial skin and skin structure infections in pediatric patients: potential role of dalbavancin. Expert Rev Anti Infect Ther 2023; 21:329-341. [PMID: 36803139 DOI: 10.1080/14787210.2023.2182769] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
INTRODUCTION Acute bacterial skin and skin structure infections (ABSSSIs) are a subtype of skin and soft tissue infections (SSTI), usually sustained by Gram-positive bacteria, whose incidence is high among children. ABSSSIs are responsible for a considerable number of hospitalizations. Moreover, as multidrug resistant (MDR) pathogens become widespread, the pediatric category seems burdened with an increased risk of resistance and treatment failure. AREAS COVERED To obtain a view on the status of the field, we describe the clinical, epidemiological, and microbiological aspects of ABSSSI in children. Old and new treatment options were critically revised with a focus on the pharmacological characteristics of dalbavancin. Evidence on the use of dalbavancin in children was collected, analyzed, and summarized. EXPERT OPINION Many of the therapeutic options available at the moment are characterized by the need for hospitalization or repeated intravenous infusions, safety issues, possible drug-drug interactions, and reduced efficacy on MDRs. Dalbavancin, the first long-acting molecule with strong activity against methicillin-resistant and also many vancomycin-resistant pathogens represents a game changer for adult ABSSSI. In pediatric settings, the available literature is still limited, but a growing body of evidence supports dalbavancin use in children with ABSSSI, demonstrating this drug to be safe and highly efficacious.
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Affiliation(s)
- Lorenzo Volpicelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome Roma, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome Roma, Italy
| | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome Roma, Italy
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18
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Bai F, Mazzitelli M, Silvola S, Raumer F, Restelli U, Croce D, Marchetti G, Cattelan AM. Cost analysis of dalbavancin versus standard of care for the treatment of acute bacterial skin and skin structure infections (ABSSSIs) in two Italian hospitals. JAC Antimicrob Resist 2023; 5:dlad044. [PMID: 37090914 PMCID: PMC10116602 DOI: 10.1093/jacamr/dlad044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/25/2023] [Indexed: 04/25/2023] Open
Abstract
Objectives Thanks to its long half-life, dalbavancin qualifies as an optimal drug for saving costs. We aimed to assess the cost and effectiveness of dalbavancin versus the standard of care (SoC). Patients and methods We conducted a multicentre retrospective study, including all hospitalized or outpatients diagnosed with ABSSSIs at Padua University Hospital, Padua and San Paolo Hospital, Milan (1 January 2016 to 31 July 2020). We compared patients according to antibiotic treatment (dalbavancin versus SoC), the number of lines of dalbavancin treatment, and monotherapy or combination (dalbavancin in association with other antibiotics). Primary endpoints were direct medical costs and length of hospital stay (LOS) associated with ABSSSI management; Student's t-test, chi-squared test and one-way ANOVA were used. Results One hundred and twenty-six of 228 (55.3%) patients received SoC, while 102/228 (44.7%) received dalbavancin. Twenty-seven of the 102 (26.5%) patients received dalbavancin as first-line treatment, 46 (45.1%) as second-line, and 29 (28.4%) as third- or higher-line treatment. Most patients received dalbavancin as monotherapy (62/102; 60.8%). Compared with SoC, dalbavancin was associated with a significant reduction of LOS (5 ± 7.47 days for dalbavancin, 9.2 ± 5.59 days for SoC; P < 0.00001) and with lower mean direct medical costs (3470 ± 2768€ for dalbavancin; 3493 ± 1901€ for SoC; P = 0.9401). LOS was also reduced for first-line dalbavancin, in comparison with second-, third- or higher-line groups, and for dalbavancin monotherapy versus combination therapy. Mean direct medical costs were significantly lower in first-line dalbavancin compared with higher lines, but no cost difference was observed between monotherapy and combination therapy. Conclusions Monotherapy with first-line dalbavancin was confirmed as a promising strategy for ABSSSIs in real-life settings, thanks to its property in reducing LOS and saving direct medical costs.
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Affiliation(s)
| | | | - Sofia Silvola
- Carlo Cattaneo—LIUC University, Castellanza, VA, Italy
- Department of Public Health Medicine, School of Health System & Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | - Umberto Restelli
- Carlo Cattaneo—LIUC University, Castellanza, VA, Italy
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Davide Croce
- Carlo Cattaneo—LIUC University, Castellanza, VA, Italy
- Department of Public Health Medicine, School of Health System & Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | - Anna Maria Cattelan
- Infectious and Tropical Diseases Unit Department, Padua University Hospital, Padua, Italy
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Koumaki D, Koumaki V, Ioannou P, Evangelou G. Dalbavancin for the treatment of severe hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2023; 37. [PMID: 36974589 DOI: 10.1111/jdv.19078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 03/15/2023] [Indexed: 03/29/2023]
Affiliation(s)
- D Koumaki
- Department of Dermatology, University Hospital of Heraklion, Heraklion, Crete, 71110, Greece
| | - V Koumaki
- Department of Microbiology, Medical School of Athens, Tetrapoleos 18, Goudi, Athens, 115 27, Greece
| | - P Ioannou
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
- School of Medicine, University of Crete, Crete, Greece
| | - G Evangelou
- Department of Dermatology, University Hospital of Heraklion, Heraklion, Crete, 71110, Greece
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20
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Abdellaoui S, Gregoire M, Dubert M, Cheminet G, Arlet JB, Lafont E. Suboptimal dalbavancin dosages in an adult with sickle-cell disease and glomerular hyperfiltration. J Antimicrob Chemother 2023; 78:851-852. [PMID: 36702764 DOI: 10.1093/jac/dkad013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Abstract
This article has been retracted. Please see: https://doi.org/10.1093/jac/dkad283
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Affiliation(s)
- Salomé Abdellaoui
- Université Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Service de Médecine Interne, Centre National de Référence de Drépanocytose, 20 rue Leblanc, Paris 75015, France
| | - Matthieu Gregoire
- Nantes Université, CHU Nantes, Cibles et Médicaments des Infections et de l'Immunité, 9 IICiMed, UR 1155, F-44000 Nantes, France
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique, F-44000 Nantes, France
| | - Marie Dubert
- Université Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Service de Microbiologie, Unité Mobile d'Infectiologie, Paris 75015, France
| | - Geoffrey Cheminet
- Université Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Service de Médecine Interne, Centre National de Référence de Drépanocytose, 20 rue Leblanc, Paris 75015, France
| | - Jean-Benoît Arlet
- Université Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Service de Médecine Interne, Centre National de Référence de Drépanocytose, 20 rue Leblanc, Paris 75015, France
| | - Emmanuel Lafont
- Université Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Service de Médecine Interne, Centre National de Référence de Drépanocytose, 20 rue Leblanc, Paris 75015, France
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21
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Giorgobiani M, Burroughs MH, Antadze T, Carrothers TJ, Riccobene TA, Patel R, Lin T, Stefanova P. The Safety and Efficacy of Dalbavancin and Active Comparator in Pediatric Patients With Acute Bacterial Skin and Skin Structure Infections. Pediatr Infect Dis J 2023; 42:199-205. [PMID: 36476623 PMCID: PMC9935565 DOI: 10.1097/inf.0000000000003798] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Acute bacterial skin and skin structure infections (ABSSSIs) are a significant source of morbidity in children. Dalbavancin, approved for the treatment of adults and children with ABSSSI, has a well-established safety profile in adults. We report safety and descriptive efficacy data for the treatment of ABSSSI in children. METHODS Children with ABSSSI (birth-<18 years old) or sepsis (<3 months old) known/suspected to be caused by susceptible Gram-positive organisms were enrolled in this phase 3, multicenter, open-label, comparator-controlled study (NCT02814916). Children ≥3 months old were randomized 3:3:1 to receive single-dose dalbavancin, 2-dose dalbavancin, or a comparator antibiotic in 4 age cohorts; those <3 months old received single-dose dalbavancin. Clinical response and microbiologic efficacy were evaluated 48-72 hours and 14, 28 and 54 days posttreatment. Bowel flora testing and audiology were collected in a subset of patients at baseline and day 28. Adverse events (AEs) were collected throughout the study. RESULTS Treatment-emergent AEs occurred in 7.2%, 9.0% and 3.3% of patients in dalbavancin single-dose, dalbavancin 2-dose and comparator arms, respectively. Three serious AEs occurred in the dalbavancin single-dose arm; no treatment-related AEs, serious AEs, or AEs leading to study discontinuation were reported. Favorable clinical response at 48-72 hours was documented in 97.4%, 98.6% and 89.7% of patients. Safety and efficacy were comparable across age cohorts. The microbiologic intent-to-treat population had comparable clinical response for all baseline pathogens, including methicillin-resistant Staphylococcus aureus . CONCLUSION The safety profile of dalbavancin was consistent in children and adults with ABSSSI. No new safety signals were identified.
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Affiliation(s)
| | | | | | | | | | | | - Tao Lin
- AbbVie Inc., Madison, New Jersey
| | - Penka Stefanova
- Medical University of Plovdiv and University Hospital “St. George,” Plovdiv, Bulgaria
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22
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Papavramidis T, Gentile I, Cattelan AM, Magnasco L, Viale P, Francisci D, Kofteridis DP, Tiseo G, Giamarellos-Bourboulis EJ, Lagi F, Pinna SM, D'Amico F, La Ferla L, Panagopoulos P, Gattuso G, Sipsas NV, Ruggieri A, Cattaneo A, Corio L, Comandini A, Mascagni P, Bassetti M. REDS study: Retrospective effectiveness study of dalbavancin and other standard of care of the same IV antibiotic class in patients with ABSSSI. Int J Antimicrob Agents 2023; 61:106746. [PMID: 36758778 DOI: 10.1016/j.ijantimicag.2023.106746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/24/2022] [Accepted: 02/01/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVES Acute bacterial skin and skin-structure infections (ABSSSIs) are a common source of morbidity in both the community and hospital settings. The current standard of care (SoC) requires multiple-dose intravenous (IV) regimens, which are associated with high hospitalisation rates, concomitant event risks and costs. Dalbavancin is a lipoglycopeptide, long-acting antibiotic that is effective against Gram-positive microorganisms, including methicillin-resistant Staphylococcus aureus (MRSA). Dalbavancin allows treatment of ABSSSIs with a single-shot IV administration or once weekly for 2 weeks, enabling clinicians to treat patients in an outpatient setting or to shorten the length of hospital stay. METHODS This multicentre, observational, retrospective study compared hospitalised patients who received dalbavancin and patients treated with the three most used IV antibiotics of the same or similar class: vancomycin, teicoplanin and daptomycin. The primary outcome was the time to discharge after starting the study antibiotics. RESULTS The primary endpoint, time to discharge from the study therapy start, was measured for both groups: the median number of days was 6.5 in the dalbavancin group vs. 11.0 days in the SoC group. Moreover, in subpopulations of patients receiving one or more concomitant antibiotics active for Gram-positives, MRSA and patients with the most prevalent comorbidity (i.e., diabetes), the advantage of dalbavancin in terms of length of stay was confirmed, with a halved time to discharge or more. Safety data on dalbavancin were consistent with data collected in clinical trials. No serious adverse drug reactions related to dalbavancin were reported and most of them were classified as skin and subcutaneous tissue disorders. One serious ADR was reported for daptomycin. CONCLUSIONS Although the analysis was only descriptive, it can be concluded that dalbavancin may enable a remarkable reduction in length of hospital stay, also confirming the clinical effectiveness and good safety profile demonstrated in clinical trials in a real-world setting.
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Affiliation(s)
- Theodossis Papavramidis
- 1st Propaedeutic Department of Surgery, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II - Naples, Italy
| | - Anna Maria Cattelan
- Clinic of Infectious Diseases, Department of Internal Medicine, University Hospital of Padua, Padua, Italy
| | - Laura Magnasco
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa and Hospital Policlinico San Martino - IRCCS, Genoa, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit - Department of Medical and Surgical Sciences, University of Bologna, Teaching Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Daniela Francisci
- Infectious Diseases Clinic, University Hospital "S. Maria della Misericordia", University of Perugia, Perugia, Italy
| | - Diamantis P Kofteridis
- University Hospital of Heraklion, Department of Internal Medicine, Heraklion, Crete, Greece
| | - Giusy Tiseo
- Infectious Disease Unit, Azienda Ospedaliera Universitaria Pisana, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Filippo Lagi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | | | - Federico D'Amico
- Clinic of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Lucia La Ferla
- Infectious Diseases Unit, Cannizzaro Hospital, Catania, Italy
| | - Periklis Panagopoulos
- Department of Internal Medicine, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Gianni Gattuso
- Department of Infectious Diseases, Carlo Poma Hospital, Mantua, Italy
| | - Nikolaos V Sipsas
- Infectious Diseases Unit, Pathophysiology Department, Laikon General Hospital and National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | | | | | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa and Hospital Policlinico San Martino - IRCCS, Genoa, Italy
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23
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Fazili T, Bansal E, Garner D, Gomez M, Stornelli N. Dalbavancin as sequential therapy for infective endocarditis due to Gram-positive organisms: a review. Int J Antimicrob Agents 2023; 61:106749. [PMID: 36758775 DOI: 10.1016/j.ijantimicag.2023.106749] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 01/25/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023]
Abstract
Dalbavancin is a parenteral lipoglycopeptide antibiotic derived from teicoplanin, an analogue of vancomycin. It is mainly used for skin and soft tissue infections. The sustained half-life of approximately 14 days makes dalbavancin a novel option for potential use as sequential treatment in infections such as infective endocarditis, which require prolonged antibiotic courses. However, only a few studies have been reported in the literature, and the use of dalbavancin remains limited. This article is a review of the currently available literature using dalbavancin for the treatment of infective endocarditis due to Gram-positive organisms. Almost all patients received dalbavancin as sequential therapy following standard-of-care antibiotics. The overall clinical efficacy of dalbavancin was approximately 90%, and it appeared to be well tolerated.
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Affiliation(s)
- T Fazili
- Infectious Disease Section, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
| | - E Bansal
- Infectious Disease Section, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - D Garner
- Infectious Disease Section, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - M Gomez
- Infectious Disease Section, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - N Stornelli
- Department of Pharmacy, Carilion Clinic, Roanoke, VA, USA
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24
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Kotsaki A, Tziolos N, Kontopoulou T, Koutelidakis IM, Symbardi S, Reed V, O'Hare M, Alexiou Z, Sambatakou H, Toutouzas K, Akinosoglou K, Lada M, Giamarellos-Bourboulis EJ, MacGowan A. Oral minocycline plus rifampicin versus oral linezolid for complicated skin and skin structure infections caused by methicillin-resistant Staphylococcus aureus: The AIDA open label, randomized, controlled Phase 4 trial. EClinicalMedicine 2023; 56:101790. [PMID: 36618892 PMCID: PMC9813692 DOI: 10.1016/j.eclinm.2022.101790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The need for oral, cost-effective treatment for complicated skin and skin structure infections (cSSSIs) due to methicillin-resistant Staphylococcus aureus (MRSA) was addressed by the non-inferiority comparisons of oral minocycline plus rifampicin with linezolid. METHODS In the AIDA multicenter, open label, randomized, controlled clinical trial, hospitalized adults with cSSSI and documented MRSA were randomly assigned at a 2:1 ratio to either oral 600 mg rifampicin qd plus 100 mg minocycline bid or oral 600 mg linezolid bid for 10 days. The primary endpoint was the clinical cure rate in the clinically evaluable (CE) population at the test-of-cure visit (14 days). Non-inferiority was confirmed if the lower confidence limit (CI) did not fall below the accepted error margin of 15%. The study is registered with EudraCT number 2014-001276-56. FINDINGS 123 patients recruited between November 2014 and January 2017 were randomly assigned to treatment (81 patients to minocycline plus rifampicin and 42 patients to linezolid). Cure rates were 78.% (46/59, 90% CI 67.3-86.5) and 68.6% (24/35, 90% CI 53.4-81.3), respectively (P = 0.337). The percent difference in cure rates was 9.4% (90% CI -7.2 to 26.8%). Minocycline plus rifampicin combination was deemed non-inferior to linezolid as the lower CI was -7.2% i.e. smaller than the accepted error margin of -15%. Although statistically not significant, the overall rate of adverse events was higher in the linezolid group (47.6%, 20/42 versus 38.3%, 31/81). INTERPRETATION Oral minocycline plus rifampicin was non-inferior to oral linezolid treatment providing alternative oral treatment for cSSSI. FUNDING The EU Seventh Research Framework Programme.
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Affiliation(s)
- Antigone Kotsaki
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Hellenic Institute for the Study of Sepsis, Athens, Greece
| | - Nikolaos Tziolos
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Hellenic Institute for the Study of Sepsis, Athens, Greece
| | - Theano Kontopoulou
- 5th Department of Internal Medicine, Evangelismos Athens General Hospital, Athens, Greece
| | | | - Styliani Symbardi
- 1st Department of Internal Medicine, Thriasio General Hospital of Eleusis, Magoula, Greece
| | - Vaughan Reed
- Micron Research Ltd, 109B Lancaster Way, Ely CB6 3NX, United Kingdom
| | - Miriam O'Hare
- Micron Research Ltd, 109B Lancaster Way, Ely CB6 3NX, United Kingdom
| | - Zoi Alexiou
- 2nd Department of Internal Medicine, Thriasio General Hospital of Eleusis, Magoula, Greece
| | - Helen Sambatakou
- 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Toutouzas
- 1st Department of Propedeutic Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Karolina Akinosoglou
- Department of Internal Medicine, Medical School, University of Patras, Rion, Greece
| | - Malvina Lada
- 2nd Department of Internal Medicine, Sismanogleion General Hospital, Athens, Greece
| | - Evangelos J. Giamarellos-Bourboulis
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Hellenic Institute for the Study of Sepsis, Athens, Greece
| | - Alasdair MacGowan
- Bristol Centre for Antimicrobial Research & Evaluation (BCARE), Infection Sciences, Science Quarter, Southmead Hospital, Bristol BS10 5NB, United Kingdom
- Corresponding author.
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25
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Population Pharmacokinetic and Pharmacokinetic/Pharmacodynamic Target Attainment Analyses for Dalbavancin in Pediatric Patients. Pediatr Infect Dis J 2023; 42:99-105. [PMID: 36638392 PMCID: PMC9835671 DOI: 10.1097/inf.0000000000003764] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Dalbavancin, approved for the treatment of pediatric and adult patients with acute bacterial skin and skin structure infections, has a terminal half-life of >14 days allowing administration as a single-dose regimen. METHODS We developed a population pharmacokinetic (PK) model using 1124 dalbavancin concentrations from 211 pediatric patients, with allometric scaling of clearance and volume parameter exponents fixed at 0.75 and 1, respectively. Serum albumin was included as a covariate on all PK parameters; creatinine clearance or estimated glomerular filtration rate was a covariate on clearance. The final model, qualified by visual predictive checks and bootstrapping, was used to simulate 1000 PK profiles for a range of pediatric age groups. PK/pharmacodynamic target attainment (PTA) was calculated for targets associated with stasis, 1-log kill, and 2-log kill of Staphylococcus aureus (neutropenic murine thigh infection model). RESULTS Dalbavancin PK was well characterized by a three-compartment model. No additional significant covariates were identified. Simulations showed that single-dose (30-minute intravenous infusion) regimens of 22.5 mg/kg (patients <6 years) and 18 mg/kg (patients 6 years to <18 years) resulted in PTA ≥94% for minimal inhibitory concentrations ≤2 mg/L and ≤0.5 mg/L for the stasis and 2-log kill targets, respectively. PTA for pediatric patients was similar to adults with exposures within the range for adults administered 1500 mg dalbavancin. CONCLUSION Dalbavancin PK in pediatric patients was well characterized by a three-compartment model. Simulations with the final model demonstrated adequate PTA across the entire age range for the approved pediatric dalbavancin doses.
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Jackson BT, Cluck DB, Henao-Martínez AF, Chastain DB. Kimyrsa and Orbactiv - A Tale of Two Formulations. Drug Des Devel Ther 2023; 17:737-742. [PMID: 36923104 PMCID: PMC10010140 DOI: 10.2147/dddt.s324285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/28/2023] [Indexed: 03/12/2023] Open
Abstract
Kimyrsa is a new formulation (NF) of the original formulation of oritavancin ([OF] Orbactiv). Comparatively, the obvious benefit with this product is the shortened infusion time and flexibility with solution compatibility, but otherwise maintains a similar pharmacokinetic and microbiologic profile. At present, the NF lacks significant real-world experience relative to other available lipoglycopeptides and thus its place in therapy remains difficult to predict but would not be expected to be significantly different than its OF.
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Affiliation(s)
- Brittany T Jackson
- Department of Pharmacy, Mount Sinai Morningside, New York, NY, 10025, USA
| | - David B Cluck
- Department of Pharmacy Practice, Bill Gatton College of Pharmacy East Tennessee State University, Johnson City, TN, 37614, USA
| | - Andrés F Henao-Martínez
- Division of Infectious Diseases, University of Colorado, Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Daniel B Chastain
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Albany, GA, 31701, USA
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27
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Evaluation of Dalbavancin in Vancomycin Allergic Patients: A Case Series. Clin Ther 2022; 44:e59-e63. [DOI: 10.1016/j.clinthera.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/31/2022] [Accepted: 11/15/2022] [Indexed: 12/02/2022]
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28
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Pinchera B, Buonomo AR, Schiano Moriello N, Scotto R, Villari R, Gentile I. Update on the Management of Surgical Site Infections. Antibiotics (Basel) 2022; 11:1608. [PMID: 36421250 PMCID: PMC9686970 DOI: 10.3390/antibiotics11111608] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 10/29/2023] Open
Abstract
Surgical site infections are an increasingly important issue in nosocomial infections. The progressive increase in antibiotic resistance, the ever-increasing number of interventions and the ever-increasing complexity of patients due to their comorbidities amplify this problem. In this perspective, it is necessary to consider all the risk factors and all the current preventive and prophylactic measures which are available. At the same time, given multiresistant microorganisms, it is essential to consider all the possible current therapeutic interventions. Therefore, our review aims to evaluate all the current aspects regarding the management of surgical site infections.
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Affiliation(s)
- Biagio Pinchera
- Department of Clinical Medicine and Surgery—Section of Infectious Diseases, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy
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Monteagudo-Martínez N, Solís-García Del Pozo J, Nava E, Ikuta I, Galindo M, Jordán J. Acute Bacterial Skin and Skin-Structure Infections, efficacy of Dalbavancin: a systematic review and meta-analysis. Expert Rev Anti Infect Ther 2022; 20:1477-1489. [PMID: 32981375 DOI: 10.1080/14787210.2021.1828865] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To know the efficacy of different doses of dalbavancin in acute bacterial skin and skin-structure infections (ABSSSIs) and versus other antibiotics. METHODS We performed a systematic review of dalbavancin efficacy for ABSSSIs. We selected 10 clinical trials from MEDLINE and Cochrane databases for qualitative review. Of these, five trials compared one or two doses of dalbavancin versus other antibiotics such as vancomycin or linezolid. RESULTS Treatment outcomes with other antibiotics were not significantly different versus two doses of dalbavancin (OR 1.13; 95% CI 0.75-1.71; p = 0.55) or single dose dalbavancin (OR 0.98; 95% CI 0.19-5.17; p = 0.98). One dose versus two doses of dalbavancin did not show significant differences in any of the treatment groups. In contrast, the global microbiological assessment results indicated a favorable outcome for two doses of dalbavancin compared to the single dose of dalbavancin (OR 2.96; 95% CI 1.19-7.39; p = 0.02) in both methicillin-resistant and methicillin-susceptible Staphylococcus aureus. CONCLUSION Either single dose or two dose dalbavancin treatment is as clinically effective as other antibiotics such as vancomycin and linezolid for the treatment of ABSSSIs.Abbreviations ABSSI: acute bacterial skin and skin-structure infection; AUC: area under the concentration-time curve; CE: clinical evaluable; CI: confidence interval; EOT: end of treatment; ITT: intention-to-treat; LOS: length of stay; MIC: minimum inhibitory concentration; MIC90: minimum concentration to inhibit growth of 90% of isolates; MR: methicillin resistant; MRSA: methicillin-resistant Staphylococcus aureus; MS: methicillin susceptible; MSSA: methicillin-susceptible Staphylococcus aureus; OPAT: Outpatient Parenteral Antimicrobial Therapy; OR: odds ratio; PI: penicillin intermediate; PR: penicillin resistant; PS penicillin susceptible; SIRS: systemic inflammatory response syndrome; SSTI: skin and soft tissue infection; TOC: test of cure; VR: vancomycin resistant; VS: vancomycin susceptible.
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Affiliation(s)
| | - Julián Solís-García Del Pozo
- Infectious Disease Unit, Department of Internal Medicine, Gerencia de Atención Integrada de Albacete, Albacete, Spain
| | - Eduardo Nava
- Area of Pharmacology, Department of Medical Sciences, Albacete School of Medicine, University of Castilla La Mancha, Albacete, Spain
| | | | - Maria Galindo
- Area of Pharmaceutical Technology, Department of Medical Sciences, School of Pharmacy, University of Castilla La Mancha, Albacete, Spain
| | - Joaquin Jordán
- Area of Pharmacology, Department of Medical Sciences, Albacete School of Medicine, University of Castilla La Mancha, Albacete, Spain
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Barlow G, Wilke M, Béraud G. Tackling Extended Hospital Stays in Patients with Acute Bacterial Skin and Skin Structure Infections. EUROPEAN MEDICAL JOURNAL 2022. [DOI: 10.33590/emj/10095006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Hospitalisation rates for acute bacterial skin and skin structure infection (ABSSSI) are rising and represent a large pharmacoeconomic burden as treatment may involve an extended number of days of antibiotic therapy. This article first aims to provide a review of treatment challenges associated with ABSSSIs in both hospital and outpatient settings, and shows that while more traditionally treatment has been conducted in a hospital setting, for a number of patients, a variety of considerations, including pharmacoeconomics, infection control, and patient preference, has led to the development of recommendations to assess the eligibility of patients for early discharge from hospital to complete their antibiotic regimen in the outpatient setting. However, such patients require monitoring for drug adherence to oral regimens or complications associated with daily intravenous administration, such as injection site reactions and infection. This review also focuses on one of a number of new antibiotics for ABSSSI, dalbavancin, as the long-acting glycopeptide with the most clinical experience to date. This antibiotic has been shown to be as effective as a daily/twice daily regimen with similar safety profiles. Health economic analysis of dalbavancin is also presented. It has shown that in some, though not all, clinical settings a reduction in the overall treatment cost is evident as, despite a higher medication cost, the lower hospitalisation time can lead to greater cost savings. In conclusion, while the burden of ABSSSI is rising, new treatment options provide additional therapeutic choice, although pharmacoeconomic considerations might limit use in some cases.
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Righi E, Visentin A, Meroi M, Carrara E, Tacconelli E. Dalbavancin in the treatment of acute bacterial skin and skin structure and other infections: a safety evaluation. Expert Opin Drug Saf 2022; 21:1171-1181. [PMID: 36093622 DOI: 10.1080/14740338.2022.2122437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Dalbavancin is a second-generation lipoglycopeptide that was approved since 2014 to treat acute bacterial skin and skin-structure infections (ABSSSI). Dalbavancin is characterized by Gram-positive activity and novel pharmacokinetic properties that result in a prolonged terminal half-life, allowing once weekly dosing in adults. A good safety profile was reported by randomized clinical trials and meta-analyses. AREAS COVERED Dalbavancin safety and tolerability data from trials and post-marketing studies were reviewed. While most trials included predominantly ABSSSI, 2 clinical trials and recent observational studies have explored the use of dalbavancin for off-label indications, mainly including bloodstream and osteoarticular infections. EXPERT OPINION The occurrence of drug-related adverse effects (AE) was similar between dalbavancin and comparators in clinical trials enrolling patients with ABSSSI. Most common AE included gastrointestinal symptoms, infusion reaction, and hypersensitivity. Low rates of drug discontinuation and serious AE were reported across studies. In the past 5 years, several observational studies have reported safety data on the use of dalbavancin, confirming its favorable safety profile. Nevertheless, data from dalbavancin off-label use often derived from prolonged (> 2 weeks) treatments with variable dosing regimens, were mainly retrospective, and lacked comparators. Further research is required to allow a reliable analysis of short- and long-term dalbavancin-related AE in non-ABSSSI.
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Affiliation(s)
- Elda Righi
- Infectious Diseases Division, Diagnostic and Public Health Department, University of Verona, Italy
| | - Alessandro Visentin
- Infectious Diseases Division, Diagnostic and Public Health Department, University of Verona, Italy
| | - Marco Meroi
- Infectious Diseases Division, Diagnostic and Public Health Department, University of Verona, Italy
| | - Elena Carrara
- Infectious Diseases Division, Diagnostic and Public Health Department, University of Verona, Italy
| | - Evelina Tacconelli
- Infectious Diseases Division, Diagnostic and Public Health Department, University of Verona, Italy
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Clinical Effectiveness and Pharmacokinetics of Dalbavancin in Treatment-Experienced Patients with Skin, Osteoarticular, or Vascular Infections. Pharmaceutics 2022; 14:pharmaceutics14091882. [PMID: 36145630 PMCID: PMC9501058 DOI: 10.3390/pharmaceutics14091882] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/08/2022] [Accepted: 08/26/2022] [Indexed: 11/18/2022] Open
Abstract
Dalbavancin (DBV) is a lipoglycopeptide approved for the treatment of Gram-positive infections of the skin and skin-associated structures (ABSSSIs). Currently, its off-label use at different dosages for other infections deserves attention. This work aimed to study the clinical effectiveness and tolerability of DBV in outpatients with ABSSSIs, osteoarticular (OA), or other infections, treated with either one or two 1500 mg doses of dalbavancin, for different scheduled periods. A liquid chromatography–tandem mass spectrometry method was used to measure total DBV concentrations. PK/PD parameters and the clinical and microbiological features of this cohort were evaluated in order to investigate the best predictors of treatment success in real-life settings. Of the 76 screened patients, 41 completed the PK study. Long-term PK was comparable to previous studies and showed significant differences between genders and dosing schedules. Few adverse events were observed, and treatment success was achieved in the vast majority of patients. Failure was associated with lower PK parameters, particularly Cmax. Concluding, we were able to describe DBV PK and predictors of treatment success in selected infections in this cohort, finding DBV Cmax as a possible candidate for therapeutic drug-monitoring purposes, as well as highlighting the dual-dose one-week-apart treatment as the optimal choice for OA infections.
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Song KH. Antibiotics for multidrug-resistant gram-positive bacteria. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2022. [DOI: 10.5124/jkma.2022.65.8.478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Antimicrobial resistance is a major global threat to public health and is associated with increased morbidity and mortality. A few therapeutic options for the treatment of multidrug resistant (MDR) gram-positive bacteria, such as methicillin resistant Staphylococcus aureus, MDR Streptococcus pneumoniae, vancomycin resistant Enterococci, are available.Current Concepts: As a result of comprehensive efforts, a dozen novel antibiotics have been developed and approved for the treatment of MDR gram-positive bacteria in the United States and Europe over the past 15 years. However, only a few antibiotics have been introduced in the Republic of Korea. The purpose of this review is to evaluate the antibiotics that act against MDR gram-positive bacteria as a primary therapeutic option. Particularly, this review focuses on novel antibiotics, including ceftaroline, ceftobiprole, telavancin, dalbavancin, oritavancin, tedizolid, delafloxacin, omadacycline, and lefamulin.Discussion and Conclusion: Novel antibiotics against MDR gram-positive bacteria have not yet been sufficiently studied in various clinical settings, and therefore, the approved indications are limited. However, these antibiotics are expected to play a major role in the treatment of MDR gram-positive bacteria owing to their advantages, including broad anti-bacterial spectrum, rapid bactericidal effect, minimal drug-drug interaction, a favorable safety profile, availability of both intravenous and oral formulations, convenient dosing scheme, and a single dose (or once a week) regimen owing to long half-life. It is crucial to introduce these novel antibiotics in the Republic of Korea for the treatment of patients suffering from MDR bacterial infections.
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Roberts E. Acute Bacterial Skin and Skin Structure Infections: Advantages and Disadvantages of Early Discharge and Outpatient Parenteral Antibiotic Therapy. EMJ MICROBIOLOGY & INFECTIOUS DISEASES 2022. [DOI: 10.33590/emjmicrobiolinfectdis/22c3790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Acute bacterial skin and skin structure infections (ABSSSI) can require long periods of antibiotic therapy. If an ABSSSI is treated while a person is in hospital, this may lead to an extended hospital stay of days or even weeks, even if the patient is in a stable enough medical condition to be discharged to their home environment. As such, inpatient treatment of an ABSSSI can incur high costs for the hospital and tie up beds that could be used for other patients. Michael Wilke from Inspiring-health GmbH, Munich, Germany, and the Medical School Hamburg, Germany, discussed with the EMJ how early discharge may be viable for patients who are medically stable and can either return to the hospital for daily treatment with intravenous (IV) infusions or are able to, reliably, take oral antibiotics. Also available are the long-acting antibiotics oritavancin and dalbavancin. The latter is administered only once via IV infusion. While the cost per dose of dalbavancin is more expensive than most oral or daily/twice daily IV antibiotic regimens, its use can facilitate early discharge, leading to reduced hospital stays and offset cost savings. Due to the administration schedule, the use of long-acting antibiotics circumvents issues with daily medication adherence.
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Shah RA, Hsu JI, Patel RR, Mui UN, Tyring SK. Antibiotic resistance in dermatology: The scope of the problem and strategies to address it. J Am Acad Dermatol 2022; 86:1337-1345. [PMID: 34555484 DOI: 10.1016/j.jaad.2021.09.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 08/26/2021] [Accepted: 09/10/2021] [Indexed: 01/05/2023]
Abstract
Antibiotic resistance is a growing health concern that has attracted increasing attention from clinicians and scientists in recent years. Although resistance is an inevitable consequence of bacterial evolution and natural selection, misuse and overuse of antibiotics play a significant role in its acceleration. Antibiotics are the mainstay of therapy for common dermatoses, including acne and rosacea, as well as for skin and soft tissue infections. Therefore, it is critical for dermatologists and physicians across all disciplines to identify, appropriately manage, and prevent cases of antibiotic resistance. This review explores dermatologic conditions in which the development of antibiotic resistance is a risk and discusses mechanisms underlying the development of resistance. We discuss disease-specific strategies for overcoming resistant strains and improving antimicrobial stewardship along with recent advances in the development of novel approaches to counter antibiotic resistance.
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Affiliation(s)
- Radhika A Shah
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas.
| | | | - Ravi R Patel
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Uyen Ngoc Mui
- Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Stephen K Tyring
- Center for Clinical Studies, Houston, Texas; Department of Dermatology, McGovern Medical School at UTHealth, Houston, Texas
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Turner NA, Zaharoff S, King H, Evans S, Hamasaki T, Lodise T, Ghazaryan V, Beresnev T, Riccobene T, Patel R, Doernberg SB, Rappo U, Fowler VG, Holland TL. Dalbavancin as an option for treatment of S. aureus bacteremia (DOTS): study protocol for a phase 2b, multicenter, randomized, open-label clinical trial. Trials 2022; 23:407. [PMID: 35578360 PMCID: PMC9109297 DOI: 10.1186/s13063-022-06370-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/28/2022] [Indexed: 11/21/2022] Open
Abstract
Background Staphylococcus aureus bacteremia is a life-threatening infection and leading cause of infective endocarditis, with mortality rates of 15–50%. Treatment typically requires prolonged administration of parenteral therapy, itself associated with high costs and potential catheter-associated complications. Dalbavancin is a lipoglycopeptide with potent activity against Staphylococcus and a long half-life, making it an appealing potential therapy for S. aureus bacteremia without the need for durable central venous access. Methods DOTS is a phase 2b, multicenter, randomized, assessor-blinded, superiority, active-controlled, parallel-group trial. The trial will enroll 200 adults diagnosed with complicated S. aureus bacteremia, including definite or possible right-sided infective endocarditis, who have been treated with effective antibiotic therapy for at least 72 h (maximum 10 days) and with subsequent clearance of bacteremia prior to randomization to study treatment. Subjects will be randomized 1:1 to complete their antibiotic treatment course with either two doses of dalbavancin on days 1 and 8, or with a total of 4–8 weeks of standard intravenous antibiotic therapy. The primary objective is to compare the Desirability of Outcome Ranking (DOOR) at day 70 for patients randomized to dalbavancin versus standard of care. Key secondary endpoints include quality of life outcomes and pharmacokinetic analyses of dalbavancin. Discussion The DOTS trial will establish whether dalbavancin is superior to standard parenteral antibiotic therapy for the completion of treatment of complicated S. aureus bacteremia. Trial registration US National Institutes of Health ClinicalTrials.govNCT04775953. Registered on 1 March 2021
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Chiriac U, Rau H, Frey OR, Röhr AC, Klein S, Meyer AL, Morath B. Validation and Application of an HPLC-UV Method for Routine Therapeutic Drug Monitoring of Dalbavancin. Antibiotics (Basel) 2022; 11:541. [PMID: 35625185 PMCID: PMC9137512 DOI: 10.3390/antibiotics11050541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 02/01/2023] Open
Abstract
Dalbavancin is emerging as a promising alternative in the ambulant treatment of gram-positive infections that require long-term antibiotic treatment such as osteomyelitis, prosthetic joint infections, and endocarditis. The aim of the current study was to develop and validate a simple, rapid, and cost-effective high-performance liquid chromatography-ultraviolet spectrometry (HPLC-UV) method for the quantification of dalbavancin. Sample clean-up included a protein precipitation protocol, followed by chromatographic separation on a reverse phase HPLC column (C-18) with gradient elution of the mobile phase. Quantification was performed with the internal standard (caffeine) method. Linear relationships between peak area responses and drug concentrations were obtained in the range of 12.5-400 mg/L. The variation coefficient of precision and the bias of accuracy (both inter- and intraday) were less than 10%. The limit of quantification (LOQ) was 12.5 mg/L. The simple and reliable HPLC-UV assay described is a powerful tool for routine therapeutic drug monitoring (TDM) of dalbavancin in human serum in clinical laboratories. With a total process time of approximately 20 min, it allows for accurate and selective quantification up to the expected pharmacokinetic peak concentrations. The method was successfully used to analyze subsequent serum samples of three patients and showed good performance in monitoring serum levels.
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Affiliation(s)
- Ute Chiriac
- Department of Pharmacy, Heidelberg University Hospital, 69120 Heidelberg, Germany;
| | - Heike Rau
- Department of Pharmacy, General Hospital of Heidenheim, 89522 Heidenheim, Germany; (H.R.); (O.R.F.); (A.C.R.)
| | - Otto R. Frey
- Department of Pharmacy, General Hospital of Heidenheim, 89522 Heidenheim, Germany; (H.R.); (O.R.F.); (A.C.R.)
| | - Anka C. Röhr
- Department of Pharmacy, General Hospital of Heidenheim, 89522 Heidenheim, Germany; (H.R.); (O.R.F.); (A.C.R.)
| | - Sabrina Klein
- Department of Infectious Diseases, Medical Microbiology and Hospital Hygiene, Heidelberg University Hospital, 69120 Heidelberg, Germany;
| | - Anna L. Meyer
- Department of Cardiac Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany;
| | - Benedict Morath
- Department of Pharmacy, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- Cooperation Unit Clinical Pharmacy, Heidelberg University, 69120 Heidelberg, Germany
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Abstract
PURPOSE OF REVIEW Acute bacterial skin and skin structure infections (ABSSSI) are a leading cause of morbidity, with a considerable variety of clinical presentation and a wide range of etiological pathogens. Of importance, the spread of multidrug-resistant (MDR) strains (i.e. methicillin-resistant Staphylococcus aureus or Gram-negative bacteria) is increasingly reported in some regions. in this review, we summarize the current clinical approach to patients with ABSSSI. RECENT FINDINGS Accurate diagnosis and identification of risk factors for MDR pathogens are key determinants for administering appropriate therapy in patients with ABSSSI. In daily clinical practice, this can be critical as there are many features defining the 'high risk patient' including both disease and host-associated risk factors. SUMMARY Antibiotic therapy should be based according to the different clinical spectrum of disease belonging to the ABSSSI, on the pathogens most likely to be involved and local resistance. Careful evaluation of antibiotic therapy after 48-72 h of initial therapy could help clinicians to early identify patients with treatment failure and to consider an alternative approach. Close monitoring of patients with multiple comorbidities, drug-drug interaction or adverse host factors are also necessary.
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New drugs for methicillin-resistant Staphylococcus aureus skin and soft tissue infections. Curr Opin Infect Dis 2022; 35:112-119. [PMID: 34812745 DOI: 10.1097/qco.0000000000000800] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Staphylococcus aureus is a pathogen incriminated in skin and soft tissue infections (SSTIs), with methicillin-resistant S. aureus (MRSA) becoming the predominant cause and representing a significant burden to the healthcare system. The last updated Infectious Diseases Society of America (IDSA) guidelines concerning MRSA infections and SSTIs management were published in 2011 and 2014, respectively. The UK updated guidelines for MRSA infection treatment were published in 2021. Older treatment options may be associated with toxicity and require frequent dosing. There is a paucity of recent reviews on the armamentarium of new agents for MRSA SSTIs treatment. RECENT FINDINGS Since 2005, several new antibiotics received a fast-track approval by the Food and Drug Administration (FDA) for SSTI treatment. These drugs include delafloxacin, omadacycline, tedizolid, ceftaroline, dalbavancin, oritavancin and telavancin. In this manuscript, we will review the data that led to these new drugs approval and discuss their advantages and disadvantages in MRSA SSTIs management. SUMMARY MRSA is a major cause of SSTIs. Several novel therapies covering MRSA were FDA-approved for SSTIs. However, the current IDSA guidelines for MRSA infection and SSTIs as well as the recently published UK guidelines on MRSA treatment only consider these drugs as alternative choices or do not mention them at all.
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40
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Current international and national guidelines for managing skin and soft tissue infections. Curr Opin Infect Dis 2022; 35:61-71. [PMID: 35067522 DOI: 10.1097/qco.0000000000000814] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Skin and soft tissue infections account for a significant percentage of both community and nosocomial infections. Several nosological entities are included in this concept. However, there is a very scarce body of doctrine for their treatment based on randomised trials. Therefore, we considered it necessary to review current treatment guidelines to bring new recommendations and improvements to our colleagues. In this review of recent literature, we identified updated guidelines in this area by searching the databases PubMed, evidence-based medicine online, York University reviewers group, Cochrane, MBE-Trip and Sumsearch using the terms: soft tissue infection, therapy, guideline. RECENT FINDINGS Developments focus on using new antimicrobials and on the prescription of shorter antibiotic treatment courses. SUMMARY With the development of new drugs and the current evidence of their use, there is a need to refine the appropriate drug's decision-making. Drugs with a long half-life, which allows weekly administration, can reduce hospital admission and length of stay with fewer healthcare resources. Shorter courses of antibiotics are recommended. The role of stewardship programmes will continue to expand. The surgical indication and its value are evident in many patients. Therefore, management should rely on a collaborative group with experience in this disease.
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Cacopardo B, Cattaneo D, Cortese F, Di Luca M, Falcone M, Marchetti G, Tascini C, Tiseo G, Venditti M. Role of dalbavancin as combination therapy: evidences from the literature and clinical scenarios. Expert Rev Anti Infect Ther 2022; 20:997-1004. [PMID: 35353020 DOI: 10.1080/14787210.2022.2060820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The off-label use of dalbavancin in patients with infections other than acute bacterial skin and skin structure infections (ABSSSI) represents an interesting therapeutic option. Its use as monotherapy or in combination with other antibiotics should be better defined. AREAS COVERED The aim of this review is to summarize evidence about the potential role of dalbavancin in combination with other antibiotics and describe clinical scenarios in which combination regimens including dalbavancin are useful. The studies were retrieved from PubMed using different combinations of keywords ("dalbavancin", "combination", "synergy"). EXPERT OPINION Limited data about the use of dalbavancin in monotherapy or combined with other antibiotics are available. In vitro assays showed a synergistic effect of dalbavancin when combined with beta-lactam antibiotics. The use of dalbavancin as combination therapy in patients with ABSSSI did not demonstrate a superiority compared to monotherapy. Conversely, combination regimens including dalbavancin may be useful in specific infection types, such as bone and prosthetic joint infections or subacute/chronic intravascular infections with no possibility of device removal. Potential partner drugs might be rifampin, beta-lactams, fluoroquinolones, doxycycline and trimethoprim/sulfamethoxazole. The choice of the companion drug should be tailored on in vitro results of synergistic tests, patient's profile and type of infection.
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Affiliation(s)
- Bruno Cacopardo
- Department of Clinical and Molecular Biomedicine, Chair of Infectious Diseases, University of Catania, 95124 Catania, Italy
| | - Dario Cattaneo
- Unit of Clinical Pharmacology, Fatebenefratelli Sacco University Hospital, Milan, Italy
| | | | | | - Marco Falcone
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Pisa
| | - Giulia Marchetti
- Clinic of Infectious Disease and Tropical Medicine, Department of Health Sciences, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy
| | - Carlo Tascini
- Department of Medicine, University of Udine, Udine, Italy
| | - Giusy Tiseo
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Pisa
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, 'Sapienza' University of Rome, Italy
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Lee HJ, Lee DG. Urgent need for novel antibiotics in Republic of Korea to combat multidrug-resistant bacteria. Korean J Intern Med 2022; 37:271-280. [PMID: 35272440 PMCID: PMC8925957 DOI: 10.3904/kjim.2021.527] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/21/2022] [Indexed: 11/27/2022] Open
Abstract
Multidrug resistance in bacteria is an important issue and is increasing in frequency worldwide because of the limitations of therapeutic agents. From 2010 to 2019, 14 new systemic antibiotics received regulatory approval in the United States. However, few new antibiotics have been introduced in Republic of Korea to combat multidrug-resistant pathogens. Here, we introduce six novel antibiotics for Gram-positive bacteria and five for Gram-negative bacteria approved by the United States Food and Drug Administration and the European Medicines Agency from 2009 to October 2021, and recommend that they be approved for use in Republic of Korea at the earliest possible date.
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Affiliation(s)
- Hyo-Jin Lee
- Division of Infectious Diseases, Department of Internal Medicine, The Catholic University of Korea, Seoul,
Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, The Catholic University of Korea, Seoul,
Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Catholic Hematology Hospital, The Catholic University of Korea, Seoul,
Korea
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43
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Ritchie H, Aggarwal A, Schimmel J, Lorenzo MP. Clinical failure of dalbavancin for MRSA bacteremia in patient with severe obesity and history of IVDU. J Infect Chemother 2022; 28:465-468. [PMID: 35016828 DOI: 10.1016/j.jiac.2021.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/18/2021] [Accepted: 12/16/2021] [Indexed: 10/19/2022]
Abstract
Dalbavancin is a lipoglycopeptide antibiotic used off-label to treat serious gram-positive infections, including infections secondary to methicillin-resistant Staphylococcus aureus (MRSA). Dalbavancin has unique pharmacokinetic parameters and has a role in therapy for treating vulnerable patients, including intravenous drug users, who have challenges complying with typical care plans for serious infections. While there is data indicating successful clinical use of dalbavancin in patients with history of intravenous drug use as well as pharmacokinetic-pharmacodynamic data assessing dalbavancin in obesity, there is a lack of information regarding clinical effects of dalbavancin in patients with extreme obesity, especially in patients with concomitant drug use. This case report describes a 40-year-old morbidly obese female actively using intravenous drugs who developed prolonged MRSA bacteremia without a recognizable focus. Despite partial treatment with dalbavancin, the patient developed osteomyelitis and discitis of the spine with associated epidural phlegmon, likely complications of the MRSA bacteremia.
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Affiliation(s)
- Hannah Ritchie
- Baystate Medical Center, Department of Pharmacy, Springfield, MA, USA
| | - Abhimanyu Aggarwal
- Department of Medicine, University of Massachusetts Medical School-Baystate, Division of Infectious Disease, Springfield, MA, USA
| | - Jennifer Schimmel
- Department of Medicine, University of Massachusetts Medical School-Baystate, Division of Infectious Disease, Springfield, MA, USA
| | - Michael P Lorenzo
- Baystate Medical Center, Department of Pharmacy, Springfield, MA, USA.
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44
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Molina KC, Miller MA, Mueller SW, Van Matre ET, Krsak M, Kiser TH. Clinical Pharmacokinetics and Pharmacodynamics of Dalbavancin. Clin Pharmacokinet 2021; 61:363-374. [PMID: 34931283 DOI: 10.1007/s40262-021-01088-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 11/29/2022]
Abstract
Dalbavancin is a synthetic lipoglycopeptide that exerts its antimicrobial activity through two distinct modes of action, inhibition of cell wall synthesis and an anchoring mechanism. Compared with previous glycopeptide antibiotics, dalbavancin demonstrates improved antibacterial potency against Gram-positive organisms and a long half-life of approximately 1 week, which is longer in tissues (e.g., skin, bone) than plasma. These factors facilitated the development of single-dose or once-weekly dosing regimens to treat acute bacterial skin and skin structure infections (ABSSSI). Dalbavancin exhibits dose-proportional pharmacokinetics and is highly protein bound (93%). Despite being highly protein bound, it has a steady-state volume of distribution >10 L and distributes widely into the skin, bone, peritoneal space, and epithelial lining fluid, but not cerebrospinal fluid. Dalbavancin elimination occurs via a combination of renal (approximately 45%) and non-renal clearance, with dose adjustments recommended only in patients with a creatinine clearance <30 mL/min not receiving any form of dialysis. The established pharmacokinetic/pharmacodynamic index associated with bacterial kill is free area under the concentration-time curve over the minimum inhibitory concentration (fAUC/MIC), with a goal 24-h fAUC/MIC of at least 27.1 for Staphylococcus aureus infections. Recent data suggest usefulness in the treatment of infections beyond ABSSSI, with convenient dosing and redosing strategies for complicated infections requiring extended treatment durations. Additional studies are needed to confirm these preliminary findings.
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Affiliation(s)
- Kyle C Molina
- Department of Pharmacy Services, University of Colorado Hospital, Aurora, CO, USA.,Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, 12850 E. Montview Blvd Mail Stop C238, Aurora, CO, 80045, USA.,Department of Medicine, Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
| | - Matthew A Miller
- Department of Pharmacy Services, University of Colorado Hospital, Aurora, CO, USA.,Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, 12850 E. Montview Blvd Mail Stop C238, Aurora, CO, 80045, USA.,Department of Medicine, Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
| | - Scott W Mueller
- Department of Pharmacy Services, University of Colorado Hospital, Aurora, CO, USA.,Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, 12850 E. Montview Blvd Mail Stop C238, Aurora, CO, 80045, USA
| | - Edward T Van Matre
- Clinical Pharmacy and Translational Science, University of Tennessee Health Sciences Center College of Pharmacy, Memphis, TN, USA
| | - Martin Krsak
- Department of Medicine, Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
| | - Tyree H Kiser
- Department of Pharmacy Services, University of Colorado Hospital, Aurora, CO, USA. .,Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, 12850 E. Montview Blvd Mail Stop C238, Aurora, CO, 80045, USA.
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Béraud G, Maupetit JC, Darras A, Vimont A, Blachier M. Dalbavancin in Real Life: Economic Impact of Prescription Timing in French Hospitals. Infect Dis Ther 2021; 11:435-449. [PMID: 34913137 PMCID: PMC8847654 DOI: 10.1007/s40121-021-00577-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/30/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The extended half-life of dalbavancin justifies a once-a-week dosing schedule and is supposed to favour early discharge. These advantages may therefore compensate for the cost of dalbavancin, but no real-life assessment has been conducted to date. We aimed to assess the real-life budget impact of dalbavancin through its impact on the length of stay in French hospitals. METHODS A multicentre cohort based on the French registry of dalbavancin use in 2019 was compared to the French national discharge summary database. Lengths of stay and budget impact related to the infection type, the time of introduction of dalbavancin, the type of catheter and patient subgroups were assessed. An early switch was defined when dalbavancin was administered as the first or second treatment and within less than 11 days of hospitalization. RESULTS A total of 179 patients were identified in the registry, and 154 were included in our study. Dalbavancin was mostly used for bone and joint infections (56.0%), infective endocarditis (19.0%) and acute bacterial skin and skin structure infections (6.0%). When compared to the data for similar patients in the national database, the length of stay was almost always shorter for patients treated with dalbavancin (up to a reduction of 13 days). The budget impact for dalbavancin was heterogeneous but frequently generated savings (up to 2257.0 €). Early switching (within less than 11 days) was associated with savings (or lesser costs), with even greater benefits within 7 days of hospitalization. Patients who required a deep venous catheter as well as the most severe patients benefited the most from dalbavancin. CONCLUSION Our study confirms that dalbavancin is associated with early discharge, which can offset its cost and generate savings. The greatest benefit is achieved with an early switch.
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Affiliation(s)
- Guillaume Béraud
- Department of Internal Medicine and Infectious Diseases, University Hospital of Poitiers, Poitiers, France.
| | | | - Audric Darras
- UNIHA Tender, Hospital Pharmacy, University Hospital of Toulouse, Toulouse, France
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Outcomes in Patients with Staphylococcus aureus Bacteremia Treated with Dalbavancin in Clinical Trials. Infect Dis Ther 2021; 11:423-434. [PMID: 34905144 PMCID: PMC8847487 DOI: 10.1007/s40121-021-00568-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 11/12/2021] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Dalbavancin is a long-acting, bactericidal, lipoglycopeptide antibiotic approved by the US Food and Drug Administration and the European Medicines Agency for treatment of acute bacterial skin and skin structure infections in adults, with potent activity against Gram-positive pathogens, including methicillin-susceptible and methicillin-resistant Staphylococcus aureus. Here we describe the clearance and clinical outcomes of patients with S. aureus bacteremia in five clinical trials of skin and skin structure infections or catheter-related bloodstream infections that evaluated the efficacy and safety of dalbavancin. METHODS Patients with uncomplicated S. aureus bacteremia identified in blood cultures drawn at baseline (before study drug) with at least one follow-up blood culture are described from four phase 3 trials in skin and skin structure infections and one phase 2 catheter-related infection study. Dalbavancin was administered as a single-dose (1500 mg intravenous [IV]) or a two-dose regimen (1000 mg IV on day 1, 500 mg IV on day 8). Comparators included vancomycin IV or linezolid IV/oral for 10-14 days. RESULTS All 39 patients (100%) who received dalbavancin, including 8 patients on the single-dose regimen, had clearance of bacteremia versus 19/20 patients (95%) treated with comparators (vancomycin or linezolid). At end of treatment, 33/36 dalbavancin-treated patients (92%) achieved clinical success versus 18/23 patients (78%) treated with comparators. CONCLUSIONS All 39 patients with uncomplicated S. aureus bacteremia treated with dalbavancin (single- or two-dose regimen) and with follow-up blood cultures had clearance of their bloodstream infection. Clinical response rates were similar to daily comparator therapy for 10-14 days. TRIAL REGISTRATION DISCOVER 1, NCT01339091; DISCOVER 2, NCT01431339; DUR001-303, NCT02127970; VER001-9; VER001-4, NCT00057369.
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Jame W, Basgut B, Abdi A. Efficacy and safety of novel glycopeptides versus vancomycin for the treatment of gram-positive bacterial infections including methicillin resistant Staphylococcus aureus: A systematic review and meta-analysis. PLoS One 2021; 16:e0260539. [PMID: 34843561 PMCID: PMC8629313 DOI: 10.1371/journal.pone.0260539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 11/11/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To compare between current evidence of novel glycopeptides against vancomycin for the treatment of gram-positive bacterial infections. METHODOLOGY A systematic review and meta-analysis was done. Major databases were searched for eligible randomized control trials that assessed clinical success, microbiological success and safety profile of novel glycopeptides versus vancomycin for infections caused by gram-positive bacteria. RESULTS This meta-analysis included eleven trials (7289 participants) comparing telavancin, dalbavancin and oritavancin with vancomycin. No differences were detected between novel glycopeptides and vancomycin for the treatment of skin and soft tissue infections (SSTIs) among modified intent-to-treat patients (OR: 1.04, CI: 0.92-1.17) as well as within the clinically evaluable patients (OR: 1.09, CI: 0.91-1.30). Data analysed from SSTIs, HAP and bacteremia studies on telavancin showed insignificant high clinical response in microbiologically evaluable patients infected with methicillin resistant Staphylococcus aureus (MRSA) (OR: 1.57, CI: 0.94-2.62, p: 0.08) and in the eradication of MRSA (OR: 1.39, CI: 0.99-1.96, P:0.06). Dalbavancin was non-inferior to vancomycin for the treatment of osteomyelitis in a phase II trial, while it was superior to vancomycin for the treatment of bacteremia in a phase II trial. Data analysed from all trials showed similar rates of all-cause mortality between compared antibiotics groups (OR: 0.67, CI: 0.11-4.03). Telavancin was significantly related with higher adverse events (OR: 1.24, CI: 1.07-1.44, P: <0.01) while dalbavancin and oritavancin were associated with significant fewer adverse events (OR: 0.73, CI: 0.57-0.94, p: 0.01; OR: 0.72, CI: 0.59-0.89, p: <0.01 respectively). CONCLUSION Efficacy and safety profiles of both dalbavancin and oritavancin were the same as vancomycin in the treatment of gram-positive bacterial infections in different clinical settings, while telavancin might be an effective alternative to vancomycin in MRSA infections, but caution is required during its clinical use due to the high risk of adverse events, especially nephrotoxicity.
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Affiliation(s)
- Wissal Jame
- Dept. of Pharmacology, University of Zawia, Alzawia, Libya
- Dept. of Clinical Pharmacy, Near East University, Lefkosa, Northern Cyprus
- * E-mail:
| | - Bilgen Basgut
- Dept. of Clinical Pharmacy, Near East University, Lefkosa, Northern Cyprus
- Dept. of Pharmacology, Baskent University, Ankara, Turkey
| | - Abdikarim Abdi
- Dept. of Clinical Pharmacy, Near East University, Lefkosa, Northern Cyprus
- Dept. of Clinical Pharmacy, Yeditepe University, Istanbul, Turkey
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Eckmann C, Tulkens PM. Current and future options for treating complicated skin and soft tissue infections: focus on fluoroquinolones and long-acting lipoglycopeptide antibiotics. J Antimicrob Chemother 2021; 76:iv9-iv22. [PMID: 34849999 PMCID: PMC8632788 DOI: 10.1093/jac/dkab351] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Bacterial skin and soft tissue infections are among the most common bacterial infections and constitute a major burden for patients and healthcare systems. Care is complicated by the variety of potential pathogens, some with resistance to previously effective antimicrobial agents, the wide spectrum of clinical presentations and the risk of progression to life-threatening forms. More-efficient care pathways are needed that can reduce hospital admissions and length of stay, while maintaining a high quality of care and adhering to antimicrobial stewardship principles. Several agents approved recently for treating acute bacterial skin and skin structure infections have characteristics that meet these requirements. We address the clinical and pharmacological characteristics of the fourth-generation fluoroquinolone delafloxacin, and the long-acting lipoglycopeptide agents dalbavancin and oritavancin.
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Affiliation(s)
- Christian Eckmann
- Department of General, Visceral and Thoracic Surgery, Klinikum Hannoversch-Muenden, Goettingen University, Germany
| | - Paul M Tulkens
- Cellular and Molecular Pharmacology, Louvain Drug Research Institute, Université catholique de Louvain (UCLouvain), Brussels, Belgium
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Oliva A, Stefani S, Venditti M, Di Domenico EG. Biofilm-Related Infections in Gram-Positive Bacteria and the Potential Role of the Long-Acting Agent Dalbavancin. Front Microbiol 2021; 12:749685. [PMID: 34745053 PMCID: PMC8569946 DOI: 10.3389/fmicb.2021.749685] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/04/2021] [Indexed: 01/08/2023] Open
Abstract
Infections caused by Gram-positive bacteria are a major public health problem due to their increasing resistance to antibiotics. Staphylococcus and Enterococcus species' resistance and pathogenicity are enhanced by their ability to form biofilm. The biofilm lifestyle represents a significant obstacle to treatment because bacterial cells become highly tolerant to a wide range of antimicrobial compounds normally effective against their planktonic forms. Thus, novel therapeutic strategies targeting biofilms are urgently needed. The lipoglycopeptide dalbavancin is a long-acting agent for treating acute bacterial skin and skin structure infections caused by a broad range of Gram-positive pathogens. Recent studies have shown promising activity of dalbavancin against Gram-positive biofilms, including methicillin-resistant S. aureus (MRSA), methicillin-resistant S. epidermidis (MRSE), and vancomycin-susceptible enterococci. This review outlines the mechanisms regulating biofilm development in Staphylococcus and Enterococcus species and the clinical impact of biofilm-related infections. In addition, it discusses the clinical implications and potential therapeutic perspectives of the long-acting drug dalbavancin against biofilm-forming Gram-positive pathogens.
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Affiliation(s)
- Alessandra Oliva
- Department of Public Health and Infectious Diseases, “La Sapienza” University of Rome, Rome, Italy
| | - Stefania Stefani
- Laboratory of Molecular Medical Microbiology and Antimicrobial Resistance Research (Mmarl), Department of Biomedical and Biotechnological Sciences (Biometec), University of Catania, Catania, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, “La Sapienza” University of Rome, Rome, Italy
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Gruss ZP, Baumeister T, Smith J. The Use of Long-Acting Lipoglycopeptides for the Treatment of Serious, Off-label Infections: a Review of the Literature. Curr Infect Dis Rep 2021. [DOI: 10.1007/s11908-021-00764-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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