Oritavancin

How it works

It inhibits bacterial cell-wall synthesis by binding to peptidoglycan precursors and also disrupts the bacterial membrane, giving bactericidal activity against Gram-positive bacteria including MRSA.

Prescribing in practice

• It artefactually prolongs coagulation tests such as aPTT and PT/INR for a period after administration and is contraindicated with intravenous unfractionated heparin during that interval, so heparin monitoring becomes unreliable.
• Its very long half-life means adverse effects can persist for an extended period after the single dose.
• It is for Gram-positive skin and soft-tissue infection only and has no useful activity against Gram-negative organisms.

Monitoring

Be aware that coagulation tests are unreliable for a period after dosing; otherwise monitor for infusion reactions and clinical response.

Counselling the patient

• This treatment is usually given as a single infusion by trained staff.
• Tell any clinician you have received it, as it can affect blood-clotting test results for some days.

Evidence & guidelines

Single-dose efficacy in skin and soft-tissue infection is supported by the SOLO randomised trials and described in the SPC.