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The game-changing property of these antibiotics is their one-time dosing.
Oritavancin (Orbactiv) and dalbavancin (Dalvance) are semisynthetic lipoglycopeptide antibiotics with activity against Gram-positive organisms, including methicillin-resistant Staphylococcus aureus. They both received FDA approval in 2014 for the treatment of acute bacterial skin and skin structure infections (ABSSSI).
The game-changing property of these antibiotics is their one-time dosing, although dalbavancin can be given as a 2-dose regimen. They also have long terminal half-lives of 245 hours and 346 hours for oritavancin and dalbavancin, respectively.
Both antibiotics are bactericidal and inhibit the transglycosylation and transpeptidation step of cell wall biosynthesis. Oritavancin also disrupts of bacterial membrane integrity, but dalbavancin does not. Given oritavancin’s dual mechanisms, the drug may have increased efficacy and reduced risk of resistance.
From an emergency department standpoint, the possibility of avoiding admission among stable patients with ABSSSI is appealing.
Both drugs are costly, with wholesale prices around $3000 to $5000, but consider the cost of vancomycin. My guess is that it’s probably not that much higher, but other pertinent pros and cons for oritavancin and dalbavancin should be taken into account when deciding whether to use these antibiotics in the emergency department.
Pros
Cons
While I believe that the use of oritavancin and dalbavancin should be rare, there may be certain cases and circumstances where the antibiotics could be ideal. Although I’m not generally a proponent of giving IV antibiotics to patients who will be discharged home, avoiding admission for patients who may need them is an attractive option.