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Hoyt A, Lawler P, Bostrom M, Carli A, Levack A. Dalbavancin is thermally stable at clinically relevant temperatures against methicillin-sensitive Staphylococcus Aureus. J Bone Jt Infect 2023; 8:175-181. [PMID: 37727824 PMCID: PMC10506503 DOI: 10.5194/jbji-8-175-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 05/28/2023] [Indexed: 09/21/2023] Open
Abstract
Introduction: While the rate of orthopaedic infections has remained constant over the years, the burden on healthcare systems continues to rise with an aging population. Local antibiotic delivery via polymethyl methacrylate bone cement is a common adjunct in treating bone and joint infections. Dalbavancin is a novel lipoglycopeptide antibiotic in the same class as vancomycin that has shown efficacy against Gram-positive organisms when used systemically but has not been investigated as a local antibiotic. This study aims to identify whether dalbavancin is thermally stable at the temperatures expected during the polymerization of polymethyl methacrylate cement. Methods: Stock solutions of dalbavancin were prepared and heated using a polymerase chain reaction machine based upon previously defined models of curing temperatures in two clinically relevant models: a 10 mm polymethyl methacrylate bead and a polymethyl methacrylate articulating knee spacer model. Aliquots of heated dalbavancin were then transferred to be incubated at core body temperature (37 ∘ C) and analyzed at various time points up to 28 d. The minimum inhibitory concentration at which 90 % of colonies were inhibited (MIC90 ) for each heated sample was determined against methicillin-sensitive Staphylococcus aureus (American Type Culture Collection, ATCC, 0173K) using a standard microbroth dilution assay. Results: The average MIC90 of dalbavancin was 1.63 µ g mL - 1 ± 0.49 against 0173K S. aureus. There were no significant differences in the relative MIC90 values after heating dalbavancin in either model compared to unheated control dalbavancin. Conclusions: Dalbavancin is thermally stable at the curing temperatures of polymethyl methacrylate cement and at human core body temperature over 28 d. Future in vitro and in vivo studies are warranted to further investigate the role of dalbavancin as a local antibiotic prior to its clinical use.
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Affiliation(s)
- Aaron K. Hoyt
- Department of Orthopaedic Surgery
& Rehabilitation, Loyola University Medical Center, Maywood, IL 60153, USA
| | - Patrick Lawler
- Stritch School of Medicine, Loyola University, Maywood, IL 60153, USA
| | - Mathias Bostrom
- Musculoskeletal Integrity Program, Hospital for Special Surgery, New
York, NY 10021, USA
- Adult Reconstruction, Hospital for Special Surgery, New York, NY
10021, USA
| | - Alberto V. Carli
- Musculoskeletal Integrity Program, Hospital for Special Surgery, New
York, NY 10021, USA
- Adult Reconstruction, Hospital for Special Surgery, New York, NY
10021, USA
| | - Ashley E. Levack
- Department of Orthopaedic Surgery
& Rehabilitation, Loyola University Medical Center, Maywood, IL 60153, USA
- Stritch School of Medicine, Loyola University, Maywood, IL 60153, USA
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2
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Monteagudo-Martínez N, Solís-García Del Pozo J, Ikuta I, Galindo M, Jordán J. Systematic review and meta-analysis on the safety of dalbavancin. Expert Opin Drug Saf 2021; 20:1095-1107. [PMID: 34042549 DOI: 10.1080/14740338.2021.1935864] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Dalbavancin is a semisynthetic lipoglycopeptide antimicrobial agent with activity against Gram-positive bacteria including anaerobes. RESEARCH DESIGN AND METHODS Meta-analysis of randomized control trials and large case series (more than 20 patients), were identified by searching Pubmed and Cochrane databases through 14 December 2020. RESULTS 3,073 patients from 6 RCTs met the inclusion criteria. Treatment emergent adverse effects were described in 30.6% dalbavancin patients, and 38.1% patients with other treatments. Our meta-analysis supports favorable results for dalbavancin treatment (OR 0.79; 95%CI 0.66-0.94; p = 0.01). 2.74% dalbavancin patients had to discontinue treatment versus 2.49% patients on other antibiotics. 4.80% dalbavancin patients versus 5.30% patients with other treatments had severe adverse events. 0.31% in the dalbavancin group and 0.95% receiving other antibiotics died. There was no statistically significant difference in severe adverse effects with OR 0.77; 95% CI 0.52-1.14; p = 0.19. Dalbavancin therapy was shown to have statistically significant lower mortality rate (OR 0.26; 95% CI 0.07-0.90; p = 0.03). Observational studies reported few side effects but included a heterogeneous population of patients concerning their diagnosis and the duration of antibiotic treatment. CONCLUSIONS Dalbavancin has comparable safety profile relative to other antibiotics and is well-tolerated.
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Affiliation(s)
- N Monteagudo-Martínez
- Department of Pharmacy. Gerencia De Atención Integrada De Villarrobledo, Albacete, Spain
| | - J Solís-García Del Pozo
- Infectious Diseases Unit. Department of Internal Medicine. Gerencia De Atención Integrada De Albacete, Albacete, Spain
| | - Ichiro Ikuta
- Department of Radiology & Biomedical Imaging Yale University School of Medicine, New Haven, Connecticut, USA
| | - Mf Galindo
- Pharmaceutical Technologic. Medical Sciences Department. Albacete School of Pharmacy. University of Castilla-La Mancha, Albacete, Spain
| | - J Jordán
- Pharmacology. Medical Sciences Department. Albacete School of Medicine. University of Castilla-La Mancha, Albacete, Spain
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Soriano A, Rossolini GM, Pea F. The role of dalbavancin in the treatment of acute bacterial skin and skin structure infections (ABSSSIs). Expert Rev Anti Infect Ther 2020; 18:415-422. [PMID: 32223465 DOI: 10.1080/14787210.2020.1746643] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Acute bacterial skin and skin-structure infections (ABSSSI) are a subgroup of skin and soft tissue infections and are a common source of morbidity in both the community and the hospital setting. The most common cause of ABSSSI is Staphylococcus aureus, which also includes methicillin-resistant S. aureus (MRSA), together with beta-hemolytic streptococci, enterococci, and Gram-negative bacteria. Since the emergence of MRSA, the management of ABSSSI has become more challenging. Novel therapies alternative to teicoplanin and vancomycin, intravenous agents commonly used against MRSA and employed in hospitalized patients, and to other antibiotics which are used as standard of care for MRSA infection, with a higher efficacy and safer profile are worth evaluating.Areas covered: This review presents and discusses current evidence on the use of dalbavancin in the treatment of ABSSSI.Expert opinion: Dalbavancin represents a promising therapeutic choice in patients with ABSSSI, thanks to its favorable pharmacokinetic profile, valuable antimicrobial spectrum, and good safety profile.
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Affiliation(s)
- Alex Soriano
- Department of Infectious Diseases, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Federico Pea
- Department of Medicine, University of Udine, Udine, Italy.,Institute of Clinical Pharmacology, Santa Maria Della Misericordia University Hospital of Udine, Udine, Italy
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4
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Roberts KD, Sulaiman RM, Rybak MJ. Dalbavancin and Oritavancin: An Innovative Approach to the Treatment of Gram-Positive Infections. Pharmacotherapy 2016; 35:935-48. [PMID: 26497480 DOI: 10.1002/phar.1641] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Health care-associated infections, especially those caused by multidrug-resistant gram-positive organisms, such as methicillin-resistant Staphylococcus aureus (MRSA), are a growing public health threat. In 2014, the U.S. Food and Drug Administration approved two new lipoglycopeptides, oritavancin and dalbavancin, for the treatment of acute bacterial skin and skin structure infections. The rationale for the development of these antimicrobials was partly to aid in the battle against vancomycin resistance in both Staphylococcus and Enterococcus. Considered a subclass of the glycopeptide antibiotics, the new lipoglycopeptides have similar mechanisms of action of binding to the carboxyl terminal d-alanyl-d-alanine residue of the growing peptide chains but differ from their parent glycopeptides by the addition of lipophilic tails. This addition allows for these agents to have prolonged half-lives, giving them unique dosing profiles. In addition, by concentrating at the site of action, they have increased potency against MRSA compared with vancomycin, the current mainstay of therapy. In this review, we focus on comparing and contrasting these two new agents with regard to their pharmacology, mechanisms of action, spectrum of activity, safety profiles, dosage and administration, and drug and laboratory interactions, and we review the clinical trials evaluating their use.
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Affiliation(s)
| | - Rand M Sulaiman
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Detroit, Michigan
| | - Michael J Rybak
- Department of Pharmacy, Detroit Medical Center, Detroit, Michigan.,Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Detroit, Michigan.,Division of Infectious Diseases, Department of Medicine, School of Medicine, Wayne State University, Detroit, Michigan
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Dalbavancin Activity When Tested against Streptococcus pneumoniae Isolated in Medical Centers on Six Continents (2011 to 2014). Antimicrob Agents Chemother 2016; 60:3419-25. [PMID: 27001811 DOI: 10.1128/aac.00116-16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 03/14/2016] [Indexed: 12/15/2022] Open
Abstract
Dalbavancin, a novel lipoglycopeptide, was approved for use in 2014 by regulatory agencies in the United States and Europe for the treatment of skin and skin structure infections. The activity of dalbavancin was also widely assessed by determination of its activity against Streptococcus pneumoniae clinical isolates collected from patients on six continents monitored during two time intervals (2011 to 2013 and 2014). A total of 18,186 pneumococcal isolates were obtained from 49 nations and submitted to a monitoring laboratory as part of the SENTRY Antimicrobial Surveillance Program for reference susceptibility testing. The potency of dalbavancin against S. pneumoniae was consistent across the years that it was monitored, with the MIC50 and MIC90 being 0.015 and 0.03 μg/ml, respectively, and all isolates were inhibited by ≤0.12 μg/ml. The activity of dalbavancin was not adversely influenced by nonsusceptibility to β-lactams (ceftriaxone or penicillin), macrolides, clindamycin, fluoroquinolones, or tetracyclines or multidrug resistance (MDR). Regional variations in dalbavancin activity were not detected, but S. pneumoniae strains isolated in the Asia-Pacific region were more likely to be nonsusceptible to penicillin and ceftriaxone as well as to be MDR than strains isolated in North or South America and Europe. Direct comparisons of potency illustrated that dalbavancin (MIC50 and MIC90, 0.015 and 0.03 μg/ml, respectively) was 16-fold or more active than vancomycin (MIC50, 0.25 μg/ml), linezolid (MIC50, 1 μg/ml), levofloxacin (MIC50, 1 μg/ml), ceftriaxone (MIC90, 1 μg/ml), and penicillin (MIC90, 2 μg/ml). In conclusion, dalbavancin had potent and consistent activity against this contemporary (2011 to 2014) collection of S. pneumoniae isolates.
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Fernández J, Greenwood-Quaintance KE, Patel R. In vitro activity of dalbavancin against biofilms of staphylococci isolated from prosthetic joint infections. Diagn Microbiol Infect Dis 2016; 85:449-51. [PMID: 27241369 DOI: 10.1016/j.diagmicrobio.2016.05.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 05/09/2016] [Accepted: 05/11/2016] [Indexed: 10/21/2022]
Abstract
The in vitro activity of dalbavancin was tested against biofilms of 171 staphylococci associated with prosthetic joint infection. Dalbavancin minimum biofilm bactericidal concentration (MBBC) values were: MBBC50 for Staphylococcus aureus and Staphylococcus epidermidis, 1μg/mL; MBBC90 for S. aureus, 2μg/mL; MBBC90 for S. epidermidis, 4μg/mL.
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Affiliation(s)
- Javier Fernández
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Department of Functional Biology, Section of Microbiology, University of Oviedo, Oviedo, Spain; Service of Microbiology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
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Leuthner KD, Yuen A, Mao Y, Rahbar A. Dalbavancin (BI-387) for the treatment of complicated skin and skin structure infection. Expert Rev Anti Infect Ther 2016; 13:149-59. [PMID: 25578881 DOI: 10.1586/14787210.2015.995633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In the era of increasing antibiotic resistance, development of new agents that could provide therapeutic options for difficult to treat pathogens is vital. Dalbavancin is a new lipoglycopeptide recently approved by the US FDA for the treatment of acute bacterial skin and skin structure infections. A derivative of the older glycopeptide class, chemical structure alterations resulted in a molecule with a similar mechanism of action, however, with a comparatively increased activity as reflected by organism MICs. These modifications also resulted in an antibiotic with distinctive properties that allow for once-weekly dosing in the treatment of Gram-positive pathogens, including methicillin-resistant Staphylococcus aureus and drug resistant Streptococcus spp. As the first of these long acting compounds, understanding the pharmacokinetic and pharmacodynamic properties of agents like dalbavancin is essential for determining a place in therapy.
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Affiliation(s)
- Kimberly D Leuthner
- University Medical Center of Southern Nevada, 1800 W. Charleston Blvd., Las Vegas, NV 89102, USA
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8
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Juul JJ, Mullins CF, Peppard WJ, Huang AM. New developments in the treatment of acute bacterial skin and skin structure infections: considerations for the effective use of dalbavancin. Ther Clin Risk Manag 2016; 12:225-32. [PMID: 26937194 PMCID: PMC4762434 DOI: 10.2147/tcrm.s71855] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Dalbavancin, an intravenous glycopeptide, was approved by the US Food and Drug Administration in May 2014 for use in adult patients with acute bacterial skin and skin structure infections. The recommended dosing regimen for effective use of dalbavancin is 1,000 mg followed by a 500 mg dose after 1 week. Two multinational, identically designed, non-inferiority trials, DISCOVER 1 and 2, demonstrated similar early clinical success with dalbavancin compared to vancomycin with an option to switch to oral linezolid. In a recently published non-inferiority trial, a single-dose regimen of dalbavancin was compared to the traditional two-dose administration and was found to have a non-inferior clinical response. In the aforementioned trials, dalbavancin was well tolerated, with patients experiencing transient adverse events of mild to moderate severity. The prolonged half-life, excellent skin and soft tissue penetration, bactericidal activity against Gram-positive bacteria including methicillin-resistant Staphylococcus aureus, and convenient dosing make dalbavancin a reasonable option for the treatment of acute bacterial skin and skin structure infections in adult patients who have tried and failed other therapies.
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Affiliation(s)
- Janelle J Juul
- Department of Pharmacy, Froedtert & the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Caitlin F Mullins
- Department of Pharmacy, Froedtert & the Medical College of Wisconsin, Milwaukee, WI, USA
| | - William J Peppard
- Department of Pharmacy, Froedtert & the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Angela M Huang
- Department of Pharmacy, Froedtert & the Medical College of Wisconsin, Milwaukee, WI, USA
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9
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Ramdeen S, Boucher HW. Dalbavancin for the treatment of acute bacterial skin and skin structure infections. Expert Opin Pharmacother 2015; 16:2073-81. [PMID: 26239321 DOI: 10.1517/14656566.2015.1075508] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Acute bacterial skin and skin structure infections (ABSSSI) have increased in incidence and severity. The involvement of resistant organisms, particularly methicillin-resistant Staphylococcus aureus, presents additional challenges. The lipoglycopeptide dalbavancin has a prolonged half-life, high protein binding, and excellent tissue levels which led to its development as a once-weekly treatment for ABSSSI. In the pivotal DISCOVER 1 and DISCOVER 2 trials, dalbavancin proved non-inferior to vancomycin followed by linezolid when used sequentially for ABSSSI, forming the basis for its recent approval in the US and Europe for ABSSSI. AREAS COVERED A literature search of published pharmacologic and clinical data was conducted to review the chemistry, pharmacodynamics, and pharmacokinetics of dalbavancin. We also discuss its development process, highlighting efficacy and safety data from pertinent clinical trials and the role it could play in the current clinical landscape. EXPERT OPINION DISCOVER 1 and DISCOVER 2 demonstrated dalbavancin's non-inferiority to vancomycin followed by linezolid for ABSSSI and confirmed its safety and tolerability. They were among the first trials to use new, early primary efficacy endpoints, and dalbavancin was among the first agents designated a Qualified Infectious Disease Product for expedited review. Dalbavancin may prove to be a valuable option for ABSSSI patients in whom conventional therapy is limited.
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Affiliation(s)
- Sheena Ramdeen
- Tufts University School of Medicine, Tufts Medical Center, Division of Geographic Medicine and Infectious Diseases , Boston, MA , USA
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10
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Dalbavancin: Roles for Once-Weekly Antibiotics in Difficult to Treat Gram-Positive Infections. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2014. [DOI: 10.1007/s40138-014-0055-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Decousser JW, Bourgeois-Nicolaos N, Doucet-Populaire F. Dalbavancin, a long-acting lipoglycopeptide for the treatment of multidrug-resistant Gram-positive bacteria. Expert Rev Anti Infect Ther 2014; 5:557-71. [PMID: 17678421 DOI: 10.1586/14787210.5.4.557] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Dalbavancin is a new lipoglycopeptide antibiotic in late-stage clinical development as a once-weekly treatment for serious infections including skin and skin structure infections. Its in vitro potency is greater than that of vancomycin, with a MIC(90) of 0.06 mg/l for Staphylococcus aureus and coagulase-negative staphylococci (irrespective of oxacillin susceptibility), 0.06-0.12 mg/l for vancomycin-susceptible Enterococcus spp. and 0.003 mg/l or less for Streptococcus pneumoniae or beta-hemolytic streptococci. Dalbavancin has dual routes of elimination. The results of Phase II/III studies show clinical efficiency in complicated skin and skin structure infection. During clinical trials, dalbavancin was as effective as linezolid or vancomycin in the treatment of patients with complicated skin and skin structure infection, including those with methicillin-resistant S. aureus. An additional Phase II study demonstrated efficacy in catheter-related bacteremia. Other preliminary in vitro and in vivo data have identified putative interest of dalbavancin in endocarditis, osteitis, diabetic foot, respiratory tract or joint infection.
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Loffler CA, MacDougall C. Update on prevalence and treatment of methicillin-resistantStaphylococcus aureusinfections. Expert Rev Anti Infect Ther 2014; 5:961-81. [DOI: 10.1586/14787210.5.6.961] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Zhanel GG, Trapp S, Gin AS, DeCorby M, Lagacé-Wiens PRS, Rubinstein E, Hoban DJ, Karlowsky JA. Dalbavancin and telavancin: novel lipoglycopeptides for the treatment of Gram-positive infections. Expert Rev Anti Infect Ther 2014; 6:67-81. [DOI: 10.1586/14787210.6.1.67] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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14
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Update of dalbavancin spectrum and potency in the USA: report from the SENTRY Antimicrobial Surveillance Program (2011). Diagn Microbiol Infect Dis 2013; 75:304-7. [DOI: 10.1016/j.diagmicrobio.2012.11.024] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 12/20/2012] [Indexed: 11/18/2022]
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15
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Chong YP, Park SJ, Kim HS, Kim ES, Kim MN, Kim SH, Lee SO, Choi SH, Jeong JY, Woo JH, Kim YS. In vitro activities of ceftobiprole, dalbavancin, daptomycin, linezolid, and tigecycline against methicillin-resistant Staphylococcus aureus blood isolates: stratified analysis by vancomycin MIC. Diagn Microbiol Infect Dis 2012; 73:264-6. [DOI: 10.1016/j.diagmicrobio.2012.01.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Revised: 01/19/2012] [Accepted: 01/25/2012] [Indexed: 11/26/2022]
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Patel H, Vaghasiya Y, Vyas B, Chanda S. Antibiotic-resistant Staphylococcus aureus: A Challenge to Researchers and Clinicians. ACTA ACUST UNITED AC 2012. [DOI: 10.3923/bj.2012.23.45] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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17
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Bennett JW, Lewis JS, Ellis MW. Dalbavancin in the treatment of complicated skin and soft-tissue infections: a review. Ther Clin Risk Manag 2011; 4:31-40. [PMID: 18728718 PMCID: PMC2503664 DOI: 10.2147/tcrm.s46] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Increasing rates of antimicrobial resistance among strains of Streptococcus, Staphylococcus, and Enterococcus spp. have been widely documented. At least 50% of nosocomial Staphylococcus aureus infections in intensive care units in the US and UK are due methicillin-resistant S. aureus (MRSA). Drug resistance is not confined to hospitals, and community-acquired MRSA (CA-MRSA) strains are now common causes of complicated skin and soft-tissue infections (cSSTIs) in many regions. Dalbavancin is a novel parenterally administered semisynthetic lipoglycopeptide similar to the naturally produced glycopeptides vancomycin and teicoplanin. Dalbavancin features a multifaceted mechanism of action that inhibits bacterial cell wall formation by two different mechanisms that enhances its activity against a wide range of gram-positive bacteria including staphylococci, streptococci, enterococci, and some anaerobes. Additionally, dalbavancin possesses unique pharmacokinetic properties, the most significant of which is a long terminal half-life that allows for once weekly dosing. This attribute may prove to yield clinical and cost benefit. Overall, clinical trials indicate that dalbavancin is a safe, well-tolerated, and effective antimicrobial agent. In the largest investigation evaluating dalbavancin for the treatment of cSSTIs, it appeared to be as effective as linezolid. Dalbavancin, which is expected to receive FDA approval in 2008, appears to be a promising new antimicrobial agent for the treatment of cSSTIs.
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Affiliation(s)
- Jason W Bennett
- Department of Medicine-Infectious Disease Service, Brooke Army Medical Center Fort Sam Houston, TX, USA
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Karlowsky JA, Adam HJ, Poutanen SM, Hoban DJ, Zhanel GG. In vitro activity of dalbavancin and telavancin against staphylococci and streptococci isolated from patients in Canadian hospitals: results of the CANWARD 2007–2009 study. Diagn Microbiol Infect Dis 2011; 69:342-7. [DOI: 10.1016/j.diagmicrobio.2010.10.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 12/23/2010] [Indexed: 11/25/2022]
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Zhanel GG, Calic D, Schweizer F, Zelenitsky S, Adam H, Lagacé-Wiens PR, Rubinstein E, Gin AS, Hoban DJ, Karlowsky JA. New Lipoglycopeptides. Drugs 2010; 70:859-86. [DOI: 10.2165/11534440-000000000-00000] [Citation(s) in RCA: 234] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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20
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Guskey MT, Tsuji BT. A Comparative Review of the Lipoglycopeptides: Oritavancin, Dalbavancin, and Telavancin. Pharmacotherapy 2010; 30:80-94. [DOI: 10.1592/phco.30.1.80] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Biedenbach DJ, Jones RN. Multicenter evaluation of the in vitro activity of dalbavancin tested against staphylococci and streptococci in 5 European countries: results from the DECIDE Surveillance Program (2007). Diagn Microbiol Infect Dis 2009; 64:177-84. [PMID: 19249179 DOI: 10.1016/j.diagmicrobio.2008.12.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Accepted: 03/02/2009] [Indexed: 10/21/2022]
Abstract
Dalbavancin is an antimicrobial lipoglycopeptide agent that has proven activity against Gram-positive pathogens and a once weekly dosing advantage compared with other agents in the glycopeptide class. The most common pathogens isolated from skin and skin structure infections (SSSIs) include Staphylococcus aureus and beta-hemolytic streptococci (betaHS), and dalbavancin has demonstrated excellent activity against these species. This study used 18 medical center laboratories in 5 European countries to assess the activity of dalbavancin, vancomycin, and teicoplanin against S. aureus, coagulase-negative staphylococci (CoNS), and betaHS. The rank order of potency was dalbavancin (MIC(50), 0.06 microg/mL) > teicoplanin (MIC(50), 0.5 microg/mL) > vancomycin (MIC(50), 2 microg/mL) and dalbavancin (MIC(50), 0.06 microg/mL) > teicoplanin and vancomycin (MIC(50), 2 microg/mL) against S. aureus and CoNS, respectively. Dalbavancin was the most active glycopeptide tested against betaHS with all strains inhibited by < or = 0.12 microg/mL. Susceptibility to other antimicrobial classes was also evaluated with noticeable differences demonstrated between countries. Higher methicillin-resistant S. aureus (MRSA) rates were observed in Italy (44.2%) and the United Kingdom (36.8%) compared with other countries, but resistance to erythromycin (51.6-83.1%) and clindamycin (5.7-68.4%) among MRSA also varied significantly between countries. The excellent contemporary activity of dalbavancin against common Gram-positive pathogens collected in European countries suggests that dalbavancin could have a role in the treatment of various types of SSSIs.
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Activities of dalbavancin against a worldwide collection of 81,673 gram-positive bacterial isolates. Antimicrob Agents Chemother 2009; 53:1260-3. [PMID: 19124664 DOI: 10.1128/aac.01453-08] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Dalbavancin, a long-acting lipoglycopeptide, was evaluated against 81,673 isolates of staphylococci, enterococci, and streptococci collected from 33 countries during worldwide resistance surveillance (2002 to 2007). Regardless of susceptibility to oxacillin, comparable potencies for dalbavancin against Staphylococcus aureus and coagulase-negative staphylococci from all countries were noted (MIC(90), 0.06 to 0.12 microg/ml). Vancomycin-susceptible Enterococcus spp. had dalbavancin MIC(90)s comparable to those for staphylococci, whereas vancomycin-resistant strains were more resistant (MIC(50), >4 microg/ml). beta-Hemolytic and viridians group streptococci were very susceptible to dalbavancin (MIC(90), <or=0.03 microg/ml). Overall, dalbavancin was >or=16-fold more active than vancomycin against the monitored gram-positive species.
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Abstract
Dalbavancin is a semisynthetic glycopeptide antibacterial agent that is active against Gram-positive bacteria associated with complicated skin and skin structure infections (cSSSIs). It is administered as a two-dose regimen intravenously infused over 30 minutes once weekly. The efficacy of dalbavancin (1000 mg on day 1 and 500 mg on day 8) has been examined in two randomized controlled trials in adults with cSSSIs. In each study, the primary efficacy measure was clinical success at the test-of-cure or follow-up visit in clinically evaluable patients. In a randomized, controlled, double-blind, multinational, phase III trial, dalbavancin was noninferior to linezolid, with clinical success rates of 88.9% and 91.2%. In a randomized, open-label, multicentre, phase II trial, clinical success rates were 94% with dalbavancin and 76% with comparator antibacterials. Dalbavancin was generally well tolerated by adult patients with cSSSIs, with most adverse events being of mild or moderate severity.
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Colabella J, Chagan L. Dalbavancin (zeven), a novel glycopeptide for resistant gram-positive organisms. P & T : A PEER-REVIEWED JOURNAL FOR FORMULARY MANAGEMENT 2008; 33:42-57. [PMID: 19749986 PMCID: PMC2730060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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