Role of dalbavancin as combination therapy: evidence from the literature and clinical scenarios

ABSTRACT

Introduction

The off-label use of dalbavancin in patients with infections other than acute bacterial skin and skin structure infections (ABSSSI) represents an interesting therapeutic option. Its use as monotherapy or in combination with other antibiotics should be better defined.

Areas covered

The aim of this review is to summarize evidence about the potential role of dalbavancin in combination with other antibiotics and describe clinical scenarios in which combination regimens including dalbavancin are useful. The studies were retrieved from PubMed using different combinations of keywords (‘dalbavancin,’ ‘combination,’ and ‘synergy’).

Expert opinion

Limited data about the use of dalbavancin in monotherapy or combined with other antibiotics are available. In vitro assays showed a synergistic effect of dalbavancin when combined with beta-lactam antibiotics. The use of dalbavancin as a combination therapy in patients with ABSSSI did not demonstrate superiority compared to monotherapy. Conversely, combination regimens including dalbavancin may be useful in specific infection types, such as bone and prosthetic joint infections or subacute/chronic intravascular infections with no possibility of device removal. Potential partner drugs might be rifampin, beta-lactams, fluoroquinolones, doxycycline, and trimethoprim/sulfamethoxazole. The choice of the companion drug should be tailored on in vitro results of synergistic tests, patient’s profile, and type of infection.

KEYWORDS:

• Dalbavancin
• combination regimens
• bone infections
• prosthetic joint infections
• intravascular infections
• subacute endocarditis

Article highlights

• Limited data about the use of dalbavancin in monotherapy or combined with other antibiotics are available.

• The use of dalbavancin combined with other antibiotics in patients with ABSSSI did not demonstrate a superiority compared to monotherapy.

• Combination regimens may be considered in specific difficult-to-treat infections, such as bone and prosthetic joint infections or subacute/chronic intravascular infections.

• Further studies are needed to clarify the role of dalbavancin in combination with other antibiotics.

Declaration of interest

G Marchetti reports grants from GILEAD, grants from VIIV, and grants from JANNSEN. M Falcone received grants and/or speaker honoraria from MSD, Angelini, Shionogi, Pfizer, Menarini, Gileag, and Nordic Pharma. D Cattaneo received grants and/or speaker honoraria from ViiV Healthcare, MSD, Angelini, Shionogi, Pfizer, Janssen Cilag and Nordic Pharma. The reported COI are outside the submitted work. Carlo Tascini has received grants in the last two years from Correvio, Biotest, Biomerieux, Gilead, Angelini, MSD, Pfizer, Thermofisher, Zambon, Shionogi, Avir Pharma and Hikma outside the submitted work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors equally contributed to literature search, writing, and final revision of the work.

Additional information

Funding

This work received an unconditional support by Angelini Pharma, which provided funding for the organization of the expert meetings.