Antimicrobial

Dalbavancin

A long-acting lipoglycopeptide that treats serious skin infections with one or two doses instead of a week of infusions.

Strong evidenceApproved drugAdd to compare

What it is

Dalbavancin is a semisynthetic lipoglycopeptide derived from a teicoplanin-like molecule (Dalvance, Xydalba). Its very long half-life of roughly 14 days means a serious Gram-positive skin infection can be treated with a single infusion or two doses a week apart, which is why it is used for outpatient and OPAT-style care.

How it works

1
Binds D-Ala-D-Ala cell-wall precursors, blocking peptidoglycan cross-linking.
2
Its lipophilic side chain anchors it in the membrane and drives the very long half-life.
3
Bactericidal against staphylococci and streptococci, including MRSA.
4
Remains above the MIC for days after a single dose.
5
Not active against Gram-negative bacteria or enterococci to a useful degree.

What it's studied for

Acute bacterial skin and skin structure infection (DISCOVER 1 and 2)

Outpatient parenteral therapy for Gram-positive infection

Bone and joint infection (increasingly used, off-label)

Osteomyelitis and prosthetic joint infection in observational series

Reported and studied effects

Clinical cure rates non-inferior to vancomycin plus linezolid in the DISCOVER trials
Therapeutic levels maintained for one to two weeks after dosing
Fewer infusion days and earlier discharge in practice studies
Infusion reactions and rash as the main tolerability issues

Research protocol notes

Research context only

Research context only - a hospital antibiotic. Licensed regimens are a single 1500 mg intravenous dose, or 1000 mg followed one week later by 500 mg; the DISCOVER trials compared this against vancomycin with optional linezolid switch, with cure assessed at 48 to 72 hours and again at test-of-cure around day 14.

These figures are described so you can understand what researchers did. They are not a dose, a schedule, or a suggestion — and they are not a substitute for a doctor.

Possible side effects and contraindications

Safety profile

Possible side effects

Nausea and diarrhoea
Rash and pruritus
Infusion-related reactions
Raised liver enzymes
Headache
Rare hypersensitivity including severe cutaneous reactions

Contraindications and cautions

Prior hypersensitivity to glycopeptides
Caution in severe liver impairment
Not for Gram-negative infection
Pregnancy only if clearly needed

A side-effect list is never complete, and these are not the only situations that warrant caution. Anything unexpected, or anything you are unsure about, should be discussed with a doctor before use.

Evidence assessment

Strong evidenceReplicated, large human trials

Replicated, large human trials

Two large randomised, double-blind trials (DISCOVER 1 and 2) with non-inferiority against an active comparator, and regulatory approval in the EU and US.

References

References link to published literature, regulator pages or literature indexes. Where a link points to a search, it collects the peer-reviewed work on that molecule rather than a single study.

Compare Dalbavancin with another peptide →

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Antimicrobial

Colistin (polymyxin E)

A last-resort lipopeptide antibiotic kept for multidrug-resistant Gram-negative infections, at the cost of kidney toxicity.

Limited evidenceApproved drug

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Daptomycin

A lipopeptide antibiotic that disrupts bacterial membranes, approved for MRSA bloodstream and skin infections but not pneumonia.

Strong evidenceApproved drug

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Teicoplanin

A long-acting glycopeptide antibiotic used in Europe for serious Gram-positive infections, with once-daily dosing.

Moderate evidenceApproved drug