Dalbavancin

How it works

It binds the D-alanyl-D-alanine terminus of cell-wall peptidoglycan precursors, inhibiting cross-linking and cell-wall synthesis, with its lipophilic side chain prolonging activity.

Prescribing in practice

• Its very long half-life means that if a serious hypersensitivity or other adverse reaction occurs, the drug cannot be removed and effects may be prolonged.
• It should be infused over the recommended period because rapid infusion has been associated with infusion-related 'red man'-type reactions.
• Caution and possible dose adjustment apply in significant renal impairment, and cross-reactivity with other glycopeptides should be considered.

Monitoring

Monitor liver enzymes and clinical response, as transient transaminase elevations have been reported.

Counselling the patient

• Tell staff at once if you experience flushing, rash, itching or breathlessness during the infusion.
• Report any previous reaction to vancomycin or similar antibiotics before treatment.

Evidence & guidelines

Dalbavancin's efficacy in skin and skin-structure infection was demonstrated in the DISCOVER randomised trials underpinning its licence.