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On- and off-label utilization of dalbavancin and oritavancin for Gram-positive infections

Taylor Morrisette1,2, Matthew A Miller2, Brian T Montague3,4

  • 1Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.

The Journal of Antimicrobial Chemotherapy
|July 20, 2019
PubMed
Abstract

Insights

Long-acting lipoglycopeptides (laLGPs) show promise for treating Gram-positive infections beyond skin infections, potentially reducing hospital stays and costs. Further research is needed to confirm their effectiveness and safety in broader clinical applications.

Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Health Economics

Background:

  • Long-acting lipoglycopeptides (laLGPs) are FDA-approved solely for acute bacterial skin and skin structure infections (ABSSSIs).
  • These antibiotics demonstrate potential for off-label utilization, offering reductions in hospital length of stay (LOS) and associated healthcare expenditures.

Purpose of the Study:

  • To evaluate the efficacy and safety of laLGPs in treating Gram-positive infections.
  • To assess the impact of laLGP treatment on hospital LOS and estimate potential cost savings.

Main Methods:

  • A retrospective cohort study included adult patients receiving at least one dose of laLGPs.
  • Descriptive statistics were employed to analyze patient data, treatment indications, pathogens, and outcomes.

Main Results:

  • The study included 56 patients, with common indications being ABSSIs, osteomyelitis, and endocarditis. Methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) were frequent pathogens.
  • laLGPs were administered for a median of one dose, contrasting with previous antibiotics given for a median of 13 days. Clinical failure occurred in 15% of cases with adequate follow-up, and mild adverse effects were noted in 11% of patients.
  • Projected reductions in hospital LOS and costs were substantial, with an average saving of 9.18 days per person and $17,204.58 per person.

Conclusions:

  • laLGPs show promise for treating various Gram-positive infections, potentially reducing hospital LOS and the need for daily infusions.
  • Further prospective trials are necessary to validate the use of laLGPs in clinical practice for Gram-positive infections.
  • These antibiotics may offer valuable alternatives for patients not eligible for outpatient parenteral antimicrobial therapy.

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