The role of dalbavancin for Gram positive infections in the COVID-19 era: state of the art and future perspectives

ABSTRACT

Introduction

The COVID-19 pandemic has dramatically challenged the national health systems worldwide in the last months. Dalbavancin is a novel antibiotic with a long plasmatic half-life and simplified weekly administration regimens, thus representing a promising option for the outpatient treatment of Gram-positive infections and the early discharge of hospitalized patients. Dalbavancin is approved for the treatment of acute bacterial skin and skin structure infections (ABSSSIs). Many preliminary data seem to support its use in other indications, such as osteomyelitis, prosthetic joint infections, and infective endocarditis.

Areas covered

A search in the literature using validated keywords (dalbavancin, Gram-positive infections, Gram-positive cocci, ABSSSI, intravenous treatment, and long-acting antibiotics) was conducted on biomedical bibliographic databases (PubMed and Embase) from 2004 to 30 September 2020. Results were analyzed during two consensus conferences with the aim to review the current evidence on dalbavancin in Gram-positive infections, mainly ABSSSI, osteomyelitis, and infective endocarditis, highlight the main limitations of available studies and suggest possible advantages of the molecule.

Expert opinion

The board identifies some specific subgroups of patients with ABSSSIs who could mostly benefit from a treatment with dalbavancin and agrees that the design of homogenous and robust studies would allow a broader use of dalbavancin even in other clinical settings.

KEYWORDS:

• ABSSSIs
• COVID-19
• dalbavancin
• endocarditis
• Gram-positive
• long-acting
• osteomyelitis

Acknowledgments

The authors would like to thank Claudia Laterza, MD, of Sanitanova S.r.l. and Andrea Mastrangelo, MD, for draft preparation and editorial assistance.

Article highlights

• The COVID-19 pandemic has dramatically challenged the national health systems imposing measures for the reduction of hospitalisation and the implementation of territorial medicine to reduce the spread of in-hospital infections

• Many scientific publications are now available concerning the off-label use of dalbavancin for osteomyelitis, prosthetic joint infections, and infective endocarditis despite dalbavancin being a long-acting lipoglycopeptide approved for the treatment of ABSSSI

• The pharmacokinetic and pharmacodynamic properties of dalbavancin allow therapy schedules suitable for the treatment of subacute-chronic osteomyelitis, prosthetic joint infections, and infective endocarditis and also after clinical stabilization in acute forms as an alternative to oral treatment.

• Evidence of dalbavancin use in osteomyelitis and infective endocarditis are promising but considering the heterogeneity of the available studies and the limitations regarding inclusion criteria, administration regimens, outcome measures, and follow-up durations, more research is needed to standardize and increase the use of dalbavancin in indications other than ABSSSIs.

Disclosure of interest

M Andreoni has participated in advisory boards and/or received speaker honoraria from Abbvie, Bristol-Myers Squibb, Gilead Sciences, Janssen-Cilag, Merck Sharp & Dohme, Viiv Healthcare and has received study grants from Merck Sharp & Dohme, outside the submitted work. M Venditti has participated in advisory boards and/or received speaker honoraria from Angelini, Correvio, Gilead, Menarini, Merck Sharp & Dohme, Nordic Pharma, Pfizer, Sanofi, Thermo Fisher, outside the submitted work. M Bassetti has participated in advisory boards and/or received speaker honoraria from Angelini, Astellas, Bayer, Basilea, Biomerieux, Cidara, Gilead Sciences, Menarini, Merck Sharp & Dohme, Nabriva, Paratek, Pfizer, Roche, and Shionogi and has received study grants from Angelini, Basilea, Astellas, Shionogi, Cidara, Gilead Sciences, Pfizer, and Merck Sharp & Dohme, outside the submitted work. F G De Rosa has participated in advisory boards and/or received speaker honoraria from Angelini, Avir Pharma, Basilea, Biomereuix, BioTest, Correvio, Gilead Sciences, Menarini, Merck Sharp & Dohme, Nordic Pharma, Pfizer, Shionogi, and Thermo Fisher and has received study grants from Merck Sharp & Dohme, Pfizer, and Shionogi, outside the submitted work. V Esposito has participated in advisory boards and/or received speaker honoraria from AbbVie, Gilead Sciences, GSK, Merck Sharp & Dohme, Viiv Healthcare, outside the submitted work. M Falcone has received research grants and/or speaker honoraria from Angelini, Menarini, Merck Sharp & Dohme, Nordic Pharma, Pfizer, Shionogi, outside the submitted work. P Grossi reports grants from Angelini and personal fees from Angelini, Gilead Sciences, Merck Sharp & Dohme, Nordic Pharma, Paratek and Vertex, outside the submitted work. F Pea has participated in advisory boards and/or received speaker honoraria from Angelini, Basilea Pharmaceutica, Correvio, Gilead Sciences, Hikma, Merck Sharp & Dohme, Novartis, Sanofi Aventis, and Thermo Fisher, outside the submitted work. N.Petrosillo has participated in advisory boards and/or received speaker honoraria from Angelini, Becton & Dickinson, Johnson & Johnson, Merck Sharp & Dohme, Pfizer, and Shionogi, outside the submitted work. C. Tascini has received funds for speaking at symposia organized on behalf of Angelini, Biomerieux, Biotest, Gilead Sciences, Hikma, Merck, Novartis, Pfizer, Thermo Fisher, and Zambon, outside the submitted work. P. Viale has received honoraria and/or support from Biomerieux, Gilead Sciences, Merck Sharp & Dohme, Novartis, and Pfizer outside the submitted work.

Reviewer disclosures

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

Declaration of interest

No potential conflict of interest was reported by the authors.

Additional information

Funding

This paper was funded by un unrestricted grant from Angelini S.P.A.