Evaluating Dalbavancin Suppression Therapy in Patients at High Risk for Recurrent Infections

Abstract

Background:

Dalbavancin is a long-acting lipoglycopeptide commonly used off-label to treat deep-seated infections. An emerging potential niche for dalbavancin is suppressive antibiotic therapy (SAT), for which data remain limited.

Objective:

This study aimed to characterize real-world dalbavancin dosing strategies for SAT and assess associated safety and efficacy outcomes.

Methods:

This was a multicenter, multinational, retrospective, single group, descriptive study among adult patients who received at least 1 dose of dalbavancin SAT between January 1, 2018, and March 31, 2023, excluding dalbavancin doses administered for treatment of active infection. The primary endpoint was to describe dalbavancin dosing strategies for SAT. Additional endpoints included treatment-emergent adverse events (TEAEs) and clinical failure.

Results:

Forty-six patients received dalbavancin SAT for a median of 201 days (IQR, 84-313). Most patients (83%, n = 38) had a retained prosthesis or device. Most infections were monomicrobial with Staphylococcus spp. being the most prevalent pathogen (63%, n = 29). The most frequent dosing was 1500 mg IV every 2 weeks. Treatment-emergent adverse events were observed in 21 (45.7%) patients, with acute kidney injury being the most common (32.6%, n = 15). One (2.2%) TEAE, nausea, led to discontinuation or modification. Eight patients (17.4%) experienced clinical failure, defined as hospitalization or microbiological recurrence due to index pathogen, after a mean duration of 7 months.

Conclusion and Relevance:

This multicenter cohort included the largest sample size of dalbavancin SAT to date, employed across diverse infections with substantial heterogeneity in dosing strategies. Clinical failure was observed in a minority of patients and discontinuation due to adverse events was uncommon. Laboratory abnormalities, including acute kidney injury, were observed but were rarely attributed directly to dalbavancin. These findings suggest dalbavancin may represent a practical suppressive therapy option when oral agents are not feasible, though further studies are needed to define optimal dosing strategies and long-term safety.