Acute bacterial skin and skin structure infections in pediatric patients: potential role of dalbavancin

ABSTRACT

Introduction

Acute bacterial skin and skin structure infections (ABSSSIs) are a subtype of skin and soft tissue infections (SSTI), usually sustained by Gram-positive bacteria, whose incidence is high among children. ABSSSIs are responsible for a considerable number of hospitalizations. Moreover, as multidrug resistant (MDR) pathogens become widespread, the pediatric category seems burdened with an increased risk of resistance and treatment failure.

Areas covered

To obtain a view on the status of the field, we describe the clinical, epidemiological, and microbiological aspects of ABSSSI in children. Old and new treatment options were critically revised with a focus on the pharmacological characteristics of dalbavancin. Evidence on the use of dalbavancin in children was collected, analyzed, and summarized.

Expert opinion

Many of the therapeutic options available at the moment are characterized by the need for hospitalization or repeated intravenous infusions, safety issues, possible drug–drug interactions, and reduced efficacy on MDRs. Dalbavancin, the first long-acting molecule with strong activity against methicillin-resistant and also many vancomycin-resistant pathogens represents a game changer for adult ABSSSI. In pediatric settings, the available literature is still limited, but a growing body of evidence supports dalbavancin use in children with ABSSSI, demonstrating this drug to be safe and highly efficacious.

KEYWORDS:

• Dalbavancin
• ABSSSI
• children
• pediatric population
• long-acting antimicrobial

Article highlights

• ABSSSI remain a frequent condition among children causing a high number of hospitalizations, surgical procedures, antimicrobial exposure, and possible complications;

• ABSSSI etiology from MDR Gram-positive pathogens is increasing and the pediatric population is considered an at-risk group, including for community acquired methicillin-resistant S. aureus (MRSA);

• The available treatment options for MRSA are usually burdened by either considerable risk of resistance, need for hospitalization and monitoring, repeated intravenous infusions, drug–drug interaction, and sub-optimal safety profile;

• The literature on dalbavancin administration in pediatric ABSSSI is still limited but a growing body of evidence is progressively confirming what we already knew for adults;

• The recently published DUR001-306 study showed high efficacy and safety of dalbavancin for the treatment of ABSSSI in the pediatric setting. Importantly, the clinical response was similar across pathogens, including those affected by MRSA;

Scientific accuracy review

AbbVie provided a scientific accuracy review at the request of the journal.

Declaration of interests

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

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

Author contributions

All authors have substantially contributed to the conception and design of this review article and interpreting the relevant literature and been involved in writing the review article.

Additional information

Funding

This paper was not funded.