Lipoglycopeptide (Long-Acting ABSSSI / MRSA) Pregnancy: eMC §4.6: there are no data from the use of dalbavancin in pregnant women and animal studies have shown reproductive toxicity; the product is not recommended during pregnancy unless the potential expected benefit clearly justifies the potential risk to the foetus. Breast-feeding: it is unknown whether dalbavancin is excreted in human milk, but it is excreted in the milk of lactating rats and may be excreted in human milk - although poorly absorbed orally, an impact on the gastrointestinal or mouth flora of a breastfed infant cannot be excluded, so a decision must be made whether to continue/discontinue breast-feeding or therapy. Fertility: animal studies have shown reduced fertility; the potential risk for humans is unknown.

Dalbavancin

Brand names: Xydalba

Dalbavancin is a long-acting lipoglycopeptide antibiotic given intravenously for acute bacterial skin and skin-structure infections caused by susceptible Gram-positive organisms, including MRSA.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 1,500 mg total, given either as a single infusion of 1,500 mg or as 1,000 mg followed one week later by 500 mg

Route: Intravenous infusion over a 30-minute period (powder must be reconstituted and then further diluted before administration)

Frequency: Single dose, or two doses one week apart (1,000 mg then 500 mg)

eMC §4.2 (Dalbavancin 500 mg powder for concentrate for solution for infusion). A total infusion time of 30 minutes is specified to minimise the risk of infusion-related reactions - rapid infusion of glycopeptides can cause flushing of the upper body, urticaria, pruritus and/or rash, which may stop if the infusion is stopped or slowed (§4.4). ELDERLY: no dose adjustment is necessary. HEPATIC IMPAIRMENT: no dose adjustment is recommended in mild impairment (Child-Pugh A); exercise caution in moderate or severe impairment (Child-Pugh B and C) as no data are available to determine appropriate dosing. PAEDIATRIC (§4.2) - the per-kg dose differs by age band, so no single structured paediatric dose is given here: children and adolescents aged from 6 years to less than 18 years - a single dose of 18 mg/kg (maximum 1,500 mg); infants and children aged from 3 months to less than 6 years - a single dose of 22.5 mg/kg (maximum 1,500 mg); safety and efficacy in children aged less than 3 months has not been established and no posology recommendation can be made. There is insufficient information to recommend dose adjustment for patients younger than 18 years with creatinine clearance less than 30 ml/min/1.73 m2. Verify any under-18 use against a children's formulary. LIMITATIONS (§4.4): there are limited data on safety and efficacy when administered for more than two doses one week apart; in the major ABSSSI trials the infections treated were confined to cellulitis/erysipelas, abscesses and wound infections; there is no experience in severely immunocompromised patients; in mixed infections where Gram-negative bacteria are suspected, add appropriate Gram-negative cover. The US label in this bundle gives the same adult single dose of 1,500 mg (and 1,125 mg for CLcr below 30 ml/min not on regular haemodialysis, which differs from the UK figure below).

Dose adjustments

Renal

eMC §4.2: no dose adjustment is required for adult or paediatric patients with mild or moderate renal impairment (creatinine clearance 30 to 79 ml/min). No dose adjustment is required for adult patients receiving regularly scheduled haemodialysis (3 times/week), and dalbavancin may be administered without regard to the timing of haemodialysis. In adult patients with chronic renal impairment whose creatinine clearance is below 30 ml/min and who are NOT receiving regularly scheduled haemodialysis, the recommended dose is reduced to either 1,000 mg as a single infusion or 750 mg followed one week later by 375 mg. There is insufficient information to recommend dose adjustment for patients younger than 18 years with creatinine clearance less than 30 ml/min/1.73 m2. (The US label instead gives 1,125 mg as a single dose for CLcr below 30 ml/min not on regular haemodialysis - UK and US figures differ.)

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients (eMC §4.3)

Side effects

Nausea (2.4%), diarrhoea (1.9%) and headache (1.3%) - the most common reactions in phase 2/3 studies, generally mild or moderate
Constipation, abdominal pain, dyspepsia, abdominal discomfort and vomiting (uncommon); decreased appetite (uncommon)
Vulvovaginal mycotic infection, urinary tract infection, fungal infection, Clostridioides difficile colitis and oral candidiasis (uncommon)
Pruritus, urticaria and rash (uncommon); infusion-related reactions (uncommon); flushing and phlebitis (uncommon); anaphylactoid reaction and bronchospasm (rare)
Anaemia, thrombocytosis, eosinophilia, leucopenia and neutropenia (uncommon); raised ALT, AST, alkaline phosphatase, gamma-GT, LDH, uric acid and abnormal liver function tests (uncommon); dysgeusia, dizziness and insomnia (uncommon)

Interactions

Other glycopeptides (eMC §4.4): administer with caution in patients known to be hypersensitive to other glycopeptides since cross-hypersensitivity may occur
Ototoxic medicinal products (eMC §4.8, class effect): ototoxicity has been associated with glycopeptide use (vancomycin and teicoplanin), and patients receiving concomitant ototoxic medicines such as an aminoglycoside may be at increased risk
US labelling §7.2: no clinical drug-drug interaction studies have been conducted; there is minimal potential for interactions with cytochrome P450 (CYP450) substrates, inhibitors or inducers. §7.1: at therapeutic concentrations dalbavancin does not artificially prolong prothrombin time (PT) or activated partial thromboplastin time (aPTT)
The eMC §4.5 interaction section was not captured in this bundle - clinician to review it in the full SPC

Clinical monograph

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.

Reference: NICE TA543; Boucher et al. Clin Infect Dis 2014 (DISCOVER I/II); MHRA SPC Xydalba; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways