Intravenous hospital antibiotics, derived from vancomycin, against resistant gram-positive bacteria such as methicillin-resistant staphylococcus (MRSA). Dalbavancin and oritavancin last so long in the body that one or two doses are enough.
FDA (U.S.): Approved: dalbavancin (2014, Dalvance) and oritavancin (2014, Orbactiv; 2021, Kimyrsa) for acute bacterial skin and soft tissue infections; telavancin (2009, Vibativ) for complicated skin infections and for hospital-acquired pneumonia due to S. aureus.
EMA (EU): Approved: dalbavancin (2015, Xydalba) and oritavancin (2015, Orbactiv, now Tenkasi) for acute skin infections. Telavancin was authorized in 2011 (Vibativ) for hospital-acquired pneumonia due to MRSA, but the authorization was withdrawn at the holder's request in 2018.
Dose
Dalbavancin: 1,500 mg IV as a single dose, or 1,000 mg and 500 mg one week later (FDA/EMA label). Oritavancin: 1,200 mg IV as a single dose (FDA/EMA label). Telavancin: 10 mg/kg IV once a day (FDA label). Hospital use.
Safety
Nausea, diarrhea, itching, headache, and infusion reactions. Telavancin can damage the kidney, prolongs the QT interval, and was associated with higher mortality in patients with pre-existing renal impairment. Oritavancin and telavancin alter some coagulation tests. Only under hospital prescription.
Interactions
Oritavancin may increase the effect of warfarin. Oritavancin and telavancin interfere with coagulation tests (PT/INR, aPTT), which can confound anticoagulant monitoring.
Differences between women and men
Telavancin caused malformations in animal studies: the FDA label calls for a pregnancy test before using it in women of childbearing age and avoiding it during pregnancy unless the benefit justifies it.
Effect by goal · level of evidence
Dalbavancin in skin infections (DISCOVER 1 and 2)
improvesHighRCT (AA)in people
79.7% vs 79.8%
Two trials with 1,312 patients. Two weekly doses of dalbavancin were as effective as vancomycin followed by linezolid: early clinical response of 79.7% vs 79.8%. It had fewer adverse effects.
Single-dose oritavancin in skin infections (SOLO I)
improvesHighRCT (AA)in people
82.3% vs 78.9%
Phase 3 trial with 954 patients. A single 1,200 mg IV dose of oritavancin achieved an early response of 82.3% vs 78.9% with 7–10 days of vancomycin; results were also similar with MRSA. Nausea was somewhat more frequent.
They block the construction of the bacterial wall, like vancomycin. They also have a lipid tail that anchors them to the bacterial membrane and greatly lengthens their time in the body (dalbavancin, more than a week). Oritavancin and telavancin also directly damage the membrane.
What the evidence says
In people
Dalbavancin in skin infections (DISCOVER 1 and 2). Two trials with 1,312 patients. Two weekly doses of dalbavancin were as effective as vancomycin followed by linezolid: early clinical response of 79.7% versus 79.8%. It had fewer adverse effects. PubMed 24897082
Single-dose oritavancin in skin infections (SOLO I). Phase 3 trial with 954 patients. A single IV dose of 1,200 mg of oritavancin achieved an early response of 82.3% versus 78.9% with 7–10 days of vancomycin; results were also similar with MRSA. Nausea was somewhat more frequent. PubMed 24897083