Experience of use of dalbavancin for the treatment of unlicensed indications in a UK tertiary infectious diseases setting

Abstract

Background: Dalbavancin is a long-acting lipoglycopeptide with Gram-positive activity, licensed for the treatment of acute bacterial skin and skin-structure infections (ABSSSIs), although off-licence use is increasingly prevalent. We describe our experience in Liverpool of using dalbavancin for off-licence indications and as a risk-reduction strategy in patients at risk of premature hospital discharge.

Methods: Patients receiving dalbavancin in the period 1/9/2020-30/4/2024 in Liverpool were identified. Data was extracted by review of patient notes. Primary outcomes were clinical success (resolution of infection without re-admission or further antibiotics) and 90-day mortality.

Results: Ninety-five individual dalbavancin courses were identified. 24/95 were for licensed indications (i.e., ABSSSI without bacteraemia). Off-licence indications included bone and joint infections (BJIs) (30/95), infective endocarditis (IE) (13/95) and Staphylococcus aureus bacteraemia (SAB) (27/95). The clinical success rate and 90-day mortality for ABSSSI without bacteraemia were 91.67% and 4.17%, respectively. BJI without bacteraemia and SAB outcomes were similar (p > 0.999). However, IE had worse rates of clinical success (61.5%, p = 0.072) and 90-day mortality (30.8%, p = 0.042). 10/18 PWIDs who were prematurely discharged achieved clinical success; 17/18 were alive at 90 days.

Conclusion: The data in this retrospective analysis adds to the growing body of evidence that dalbavancin is safe and effective for the treatment of BJIs and SABs. It also reinforces the uncertainty in the literature over the efficacy of use in IE. Additionally, these data demonstrate that dalbavancin may be used successfully as a risk mitigation strategy for PWIDs who may be prematurely discharged from an inpatient stay.

Keywords: Bacteraemia; Boint and joint infection; Dalbavancin; Infective endocarditis; Lipoglycopeptides; Off-licence; Osteomyelitis; Outpatient antibiotic therapy; PWIDs; Skin and soft tissue infection; Staphylococcus aureus.