Dalbavancin

How it works

It binds the terminal D-alanyl-D-alanine of cell-wall precursors, inhibiting peptidoglycan transglycosylation and transpeptidation to give a bactericidal effect against Gram-positive bacteria.

Prescribing in practice

• Its very long half-life means any serious hypersensitivity or adverse reaction cannot be quickly reversed, so it should be used in patients without a history of glycopeptide allergy and infused at the recommended rate to avoid infusion reactions.
• Rapid infusion has been linked to an infusion-related 'red-man'-type reaction, mitigated by slower administration.
• It is given by intravenous infusion and requires dose consideration in significant renal impairment.

Monitoring

Monitor for infusion reactions and hepatic transaminase changes, with clinical review of treatment response.

Counselling the patient

• Tell the team if you develop flushing, rash or itching during the infusion.
• Because the medicine lasts a long time in the body, report any allergic-type symptoms even in the days after the dose.

Evidence & guidelines

Use is supported by registration trials and product information for acute bacterial skin and soft-tissue infections.