Dalbavancin safe, has high cure rate for bone, joint and orthopedic implant-related infection
SPAIN: Dalbavancin is a well-tolerated antibiotic (even at >2 doses) and is associated with a high cure rate of 65% to 76% for the treatment of osteoarticular infections (septic arthritis, spondylodiscitis, osteomyelitis, or orthopedic implant-related infection), suggests a recent study published in the journal Antimicrobial Agents and Chemotherapy.
The authors, however, add, that these are preliminary data with a short follow-up, therefore, it is essential to gain more experience in the future in order to establish the most appropriate dose and frequency.
Dalbavancin is a lipoglycopeptide with potent activity against Gram-positive microorganisms. It has an antibiotic spectrum similar to that of vancomycin, has a long half-life (180–240 hours, allowing weekly or biweekly dosing), and a favorable safety profile. Also, it achieves high concentrations in the bone making it an interesting alternative for the treatment of osteoarticular infections.
, University of Barcelona, Barcelona, Spain, and colleagues present a retrospective case series of 64 patients treated in 30 Spanish institutions in 2016 and 2017; all received dalbavancin for bone and joint (n=19) and orthopedic implant-associated infections (n=45).
The most common pathogens were Staphylococcus epidermidis (n=30) and Staphylococcus aureus (n=14), 93% and 64% of which were methicillin-resistant. The patients had received other antibiotics for a median of 41 days (21–87), and the reasons for switching to dalbavancin included treatment simplification (53%), adverse events (25%), or failure of the previous regimen (22%).
A median of five doses were administered; most patients received 1000 mg initially, and 500 mg doses at weekly intervals thereafter.
Also Read: ICMR Antimicrobial Guidelines for Device Associated Infections
- Adverse effects without the need for treatment discontinuation occurred in 11% of patients.
- In 45 cases, infection was related to an orthopedic implant.
- The implant material was retained in 23 cases, including that in 15 (65.2%) patients that were classified as cured and 8 (34.8%) that presented improvement.
- In 21 cases, the implants were removed, including those in 16 (76.2%) cases that were considered successes, 4 (19%) cases were considered improved, and 1 (4.8%) case that was considered a failure.
- Among the 19 cases without implants, 14 (73.7%) were considered cured, 3 (15.8%) were considered improved, and 2 (10.5%) were considered failures.
- Rifampin was additionally administered in 18% and other antibiotics in 15%.
Also Read: Oral antibiotics as good as intravenous in complex bone infections: NEJM
To summarize, successful treatment was noted in 74% of bone and joint infections; the rate among implant-associated infections was 76% with retained implants and 65% in those who needed implant removal (median follow-up, 157 days).
"The results show that dalbavancin is a well-tolerated antibiotic, even when >2 doses are administered, and is associated with a high cure rate," concluded the authors.
For detailed study log on to DOI: 10.1128/AAC.02280-18