Dalbavancin Antimicrobial Prescribing Guidelines for Adult patients

• Drug information
• Administration
• Indications and dosing
• Renal impairment dosing
• Funding implications
• DIscharge information

This guideline is not for use in paediatrics. Dalbavancin is NOT licensed in patients under the age of 18 years due to lack of evidence.
Please refer to the British National Formulary (BNF) or the Summary of Product Characteristics (SPC) for information on:

• Pharmacokinetics
• Interactions
• Side effects
• Allergy information
• Use in Breastfeeding and pregnancy

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DRUG INFORMATION

Class of antimicrobial: bactericidal lipoglycopeptide

Antimicrobial spectrum: bactericidal activity against gram-positive bacteria, it doesn’t have any gram-negative activity. Dalbavancin should be co-administered with appropriate antibacterial agents or other agents should be considered in cases of mixed infections where Gram negative and/or certain types of anaerobic bacteria are suspected.

Allergy advice: use with caution in patients with other glycopeptide sensitivity. Hypersensitivity reactions and anaphylaxis have been reported with dalbavancin. If such a reaction occurs, dalbavancin administration should be stopped immediately and appropriate emergency measures taken.

Caution should be taken if a patient has had a reaction to a glycopeptide including vancomycin and teicoplanin previously.

Dalbavancin can cause infusion-related reactions and, if infused more rapidly than over 30 minutes, can cause ‘Red Man Syndrome’ reactions. Symptoms include flushing of the upper body, urticaria, pruritus and/or rash. If this occurs the infusion should be stopped.

Elimination half-life: 372 hours (1)

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ADMINISTRATION

Dalbavancin should be administered via as an intravenous infusion.

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INDICATIONS AND DOSING

Dalbavancin is licensed for acute bacterial skin and soft tissue infections; however there is evidence to suggest it can be used for other infections caused by Gram positive bacteria. Any use outside of skin and soft tissue infections is considered off-label use and this should be discussed with the patient prior to being prescribed it.
Criteria for use of dalbavancin:

• Likely Gram-positive bacterial infection, excluding vancomycin resistant organisms.
• Patient aged ≥18 years 
• No barriers to discharge other than intravenous antimicrobial therapy and able to be discharged within the next 24 hours.

No dosing adjustment is required in obesity.

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RENAL IMPAIRMENT DOSING

Creatinine clearance (CrCl) using the Cockcroft and Gault calculation should be calculated; eGFR should not be used. Calculators can be found here:
https://www.mdcalc.com/creatinine-clearance-cockcroft-gault-equation

Ideal body weight (IBW) should be used to calculate CrCl if a patient is overweight. If a patient’s actual body weight is more than 25% greater than there IBW, adjusted body weight should be used to calculate CrCl.

No adjustments are required for patients with mild or moderate renal impairment (CrCl ≥30 - 79 mL/min)

No adjustments are required for patients having haemodialysis, including HDF/Hi-Flux dialysis used for patients in Leeds.

For patients with a CrCl of <30 mL/min and for those who are having peritoneal dialysis:

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FUNDING IMPLICATIONS

Dalbavancin is red drug and will need to be issued by the hospital

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DISCHARGE INFORMATION

The Outpatient Parenteral Antimicrobial Therapy (OPAT) service can support with discharging patients requiring dalbavancin; if a second dose is required (deep seated infections only) please refer to the OPAT/CIVAS team. All doses should be supplied on discharge. The OPAT drug monographs includes all of the information required for administration, reconstitution and supply at discharge.