Long-Acting Lipoglycopeptides
GENERAL PRINCIPLES
Long-acting lipoglycopeptides are bactericidal antibiotics that inhibit bacterial cell wall biosynthesis, similar to vancomycin. Their spectrum of activity includes gram-positive aerobic pathogens only.
These agents are characterized by extremely long terminal half-lives and are currently FDA-approved for skin/soft tissue infections.TREATMENT
• Dalbavancin (1500 mg single dose or 1000 mg IV on day 1 followed by 500 mg IV on day 8 to complete the course of therapy) has a terminal half-life of 346 hours. Dalbavancin is active against staphylococci (including MRSA), streptococci, and enterococci. Susceptibility to dalbavancin can be reliably inferred from vancomycin.
• Oritavancin (1200 mg IV administered once to complete therapy) has a terminal half-life of 245 hours. Oritavancin is active against staphylococci (including MRSA), streptococci, and enterococci (including VRE).
SPECIAL CONSIDERATIONS
Adverse events include nausea, diarrhea, vomiting, headache, dizziness, pruritus, and infusion-related reactions. In clinical trials, more dalbavancin-treated patients had alanine LFT elevation greater than three times the upper limit of normal than patients treated with a comparative agent. Dalbavancin may also cause acute kidney injury.