Dalbavancin

Class and Category

Pharmacologic Class: Lipoglycopeptide

Therapeutic Class: Antibacterial antibiotic

Indications and Dosages

To treat acute bacterial skin and skin structure infections caused by Enterococcus faecalis (vancomycin susceptible strains), Staphylococcus aureus (including methicillin-susceptible and methicillin-resistant strains), Streptococcus agalactiae, S. anginosus group (including S. anginosus, S. constellatus, and S. intermedius), S. dysgalactiae, and S. pyogenes

I.V. INFUSION

Adults: 

1,500 mg infused as a single dose over 30 min. Alternatively, 1,000 mg infused over 30 min, followed by 500 mg infused over 30 min 1 wk later.

Dosage Adjustment:

For patients with renal impairment (creatinine clearance less than 30 ml/min) and who are not receiving hemodialysis, the initial dosage is reduced to 1,125 mg as a single dose or 750 mg, followed by 375 mg 1 wk later.

Mechanism of Action

Interferes with bacterial cell wall synthesis, which leads to impaired bacterial cell growth or cell death.

Incompatibilities

Do not co-infuse with other medications or electrolytes. Also, do not mix or infuse with saline-based infusion solutions because precipitation may occur.

Contraindications

Hypersensitivity to dalbavancin or its components

Interactions

None reported

Adverse Reactions

CNS: Dizziness, headache

GI: Abdominal pain, Clostridium difficile-associated colitis, diarrhea, elevated liver enzymes, gastrointestinal hemorrhage, hepatotoxicity, melena, nausea, the passage of bright red blood through the anus.

GU: Vulvovaginal mycotic infection

HEME: Anemia, elevated international normalized ratio (INR), eosinophilia, hemorrhagic anemia, leukopenia, neutropenia, spontaneous hematoma, thrombocytosis, and thrombocytopenia.

MS: Back pain

RESP: Bronchospasm

SKIN: Flushing of upper body, petechiae, pruritus, rash, urticaria

EENT: Oral candidiasis

ENDO: Hypoglycemia

Other: Anaphylaxis, phlebitis, red man syndrome (with rapid infusion), wound hemorrhage

Childbearing Considerations

PREGNANCY

• It is not known if the drug causes fetal harm.
• Use with caution only if the benefit to the mother outweighs the potential risk to the fetus.

LACTATION

• It is not known if the drug is present in breast milk.
• The patient should check with the prescriber before breastfeeding.

Nursing Considerations

• Use cautiously in patients with a history of glycopeptide allergy because of the possibility of cross-sensitivity.
• Use cautiously in patients with a history of hepatic impairment because dosing adjustments for dalbavancin in patients with moderate to severe hepatic impairment are not known. Dosage adjustment is not required for patients with mild hepatic impairment.
• Reconstitute with 25 ml of sterile water for injection, USP for each 500-mg vial. Avoid foaming by alternating between gently swirling and inverting the vial until the contents are completely dissolved. Do not shake. The solution should appear clear and colorless to yellow. Once reconstituted, the vial may be refrigerated for up to 48 hours. Do not freeze. Prior to administration, further dilute reconstituted vial by aseptically transferring the required dose from the vial to an intravenous bag or bottle containing enough solution of 5% dextrose injection, USP to provide a final dalbavancin concentration of 1 to 5 mg/ml. Discard any unused portion of the reconstituted solution. Once diluted, the intravenous bag or bottle may be refrigerated until administration as long as the total time from the vial being reconstituted until administration does not exceed 48 hours. Never freeze the diluted solution.
• Administer as an intravenous infusion over 30 minutes to minimize the risk of infusion-related reactions that resemble red man syndromes, such as flushing of the upper body, pruritus, rash, or urticaria. Monitor the patient for back pain, which also has been identified as an infusion-related reaction. If present, stopping or slowing the infusion may cause these reactions to disappear. Always flush the intravenous line with 5% dextrose injection, USP before and after administration if the line is used to administer other drugs.
• Assess the patient for signs of secondary infection, such as profuse, watery diarrhea. If such diarrhea develops, contact the prescriber and expect to obtain a stool specimen to rule out pseudomembranous colitis caused by C. difficile. If diarrhea occurs, notify the prescriber and expect to withhold dalbavancin and treat a patient with an antibiotic effective against C. difficile along with electrolytes, fluids, and protein.

PATIENT INFORMATION

• Emphasize the importance of obtaining a second dose of dalbavancin if the patient was prescribed the two-dose regimen.
• Tell the patient to immediately report any signs and symptoms of an allergic reaction.
• Advise patient to report severe diarrhea to prescriber immediately.