Abstract
Dalbavancin (DAL) is a lipoglycopeptide with bactericidal activity against a very wide range of Gram-positive microorganisms. It also has unique pharmacokinetic properties, namely a prolonged half-life (around 181 h), which allows a convenient weekly dosing regimen, and good diffusion in bone tissue. These features have led to off-label use of dalbavancin in the setting of bone and joint infection, including prosthetic joint infections (PJI). In this narrative review, we go over the pharmacokinetic and pharmacodynamic characteristics of DAL, along with published in vitro and in vivo experimental models evaluating its activity against biofilm-embedded bacteria. We also examine published experience of osteoarticular infection with special attention to DAL and PJI.
Highlights
Total joint arthroplasties are common worldwide, and the incidence of this surgery is expected to increase steadily in the coming years as the population ages [1]
The wide antimicrobial spectrum of this drug and its unique pharmacokinetic (PK) properties, with a half-life of 181 h [8] and prolonged concentrations in bone tissue [9], along with a good safety profile have led physicians to use it for a number of off-label indications [10,11], which include the treatment of bone and joint infections as well as prosthetic joint infections (PJI)
We review the drug’s PK profile, pharmacodynamic (PD) properties, activity against biofilm-embedded bacteria in in vitro and in vivo experimental models, and we evaluate the available clinical experience in PJI
Summary
Total joint arthroplasties are common worldwide, and the incidence of this surgery is expected to increase steadily in the coming years as the population ages [1]. The wide antimicrobial spectrum of this drug and its unique pharmacokinetic (PK) properties, with a half-life of 181 h [8] and prolonged concentrations in bone tissue [9], along with a good safety profile have led physicians to use it for a number of off-label indications [10,11], which include the treatment of bone and joint infections as well as PJI. Resistance emergence under DAL treatment is, possible, a very rare phenomenon In this particular setting, the need for treatment over long periods, coupled with the long half-life of DAL mean that the antibiotic can be used on a convenient weekly basis. The need for treatment over long periods, coupled with the long half-life of DAL mean that the antibiotic can be used on a convenient weekly basis In this narrative review, we assess the role of DAL in the treatment of PJI. We review the drug’s PK profile, pharmacodynamic (PD) properties, activity against biofilm-embedded bacteria in in vitro and in vivo experimental models, and we evaluate the available clinical experience in PJI
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