EXPERIENCE OF REAL-LIFE USE OF DALBAVANCIN AS AN OFF-LABEL TREATMENT OF COMPLICATED INFECTIOUS DISEASES IN A TERTIARY CARE HOSPITAL

INTRODUCTION

Dalbavancin is a long-acting lipoglycopeptide antibiotic (half-life 14.40 days) that inhibits cell wall synthesis. It is commonly used off-label, as it has potent activity against gram-positive pathogens that cause bone and joint infections.

The objective is to describe the cases in which dalbavancin has been used as an off-label use for the treatment of infections by gram-positive microorganisms in a tertiary hospital.

METHODS

Case report series study of all patients treated with dalbavancin as off-label use from January 2017 to March 2022.

Demographic, clinical and pharmacotherapeutic variables were considered: age, sex, justification for the request as off-label, diagnosis, microorganism, location, previous antibiotic treatment, posology, duration, concomitant antibiotic treatment and follow-up at 3 months.

RESULTS AND DISCUSSION

Nineteen patients were included, one of whom died, and the other received another antibiotic treatment.

Dalbavancin was administered to seventeen patients (median age 76(33-99) years, 64.70% men). The justification for off-label use was in all patients due to early discharge and impossibility of treatment with other oral antibiotics due to interactions, adverse effects and/or severity.

The main diagnosis were: bacteremia (29.40%), osteoarticular infection (52.94%) and endocarditis (11.76%). The isolated microorganism was Staphylococcus epidermidis (47.00%), methicillin-resistant Staphylococcus aureus (17.65%), methicillin-sensitive Staphylococcus aureus (23.53%), Staphylococcus haemolyticus (5.89%) and Staphylococcus warneri (5.89%). The location of the microorganism was: 33% blood culture, 25% joint fluid, 16.67% abscess, 16.67% osteosynthesis and 8.33% ulcer.

Previous antibiotic treatment: 13 patients daptomycin (76.47%) (9 of them also received other antibiotics), 3 patients linezolid (17.65%) (2 of them also received other antibiotics) and 2 patients received others (11.76%).

The posology was: 2 doses of 1500mg biweekly (17.65%), 1 dose of 1000mg+500mg at two weeks (17.65%), 1 dose of 1500mg+1000mg biweekly (23.53%), single dose of 1500 mg (11.76%), 1 dose of 750mg+375mg weekly (11.76%) and 1 dose of 1500mg+500mg weekly (17.65%).

The median number of days of treatment was 14(1-56). 29.41% patients received concomitant antibiotic treatment: rifampicin(5) and levofloxacin(2). At 3 months of treatment only 2 patient died and no patient had reinfection.

CONCLUSIONS

Dalbavancin is an antibiotic with a novel dosage in infectious diseases, whose main contribution in our setting has been to allow earlier hospital discharge in patients who did not have oral alternatives and the only reason for hospitalization was the need for intravenous antibiotic treatment. It has proven to be highly effective because no patient manifested symptoms of reinfection., which is why we have recently drawn up a protocol for its off-label use in patients who meet specific criteria.