The Use of Long-Acting Lipoglycopeptides for the Treatment of Serious, Off-label Infections: a Review of the Literature

The standard of care for serious Gram-positive bacterial infections, such as osteomyelitis and infective endocarditis, has traditionally required prolonged durations of intravenous antibiotics. Recent literature has suggested that oral antibiotics are non-inferior in certain patient populations. Despite these advancements, there are still patients with practical implications that render oral antimicrobial therapy unappealing, including history of medication non-adherence or lack of a suitable oral option given organism isolation. As a result, long acting lipoglycopeptides (dalbavancin and oritavancin) are an attractive alternative therapy to mitigate these concerns. The purpose of this focused review is to summarize the use of these antibiotic therapies for off-label indications and their associated clinical outcomes. Here, we discuss the pharmacokinetics and pharmacodynamics, published literature evaluating the treatment of bone and joint infections and infective endocarditis, and clinical utility of dalbavancin and oritavancin. Long-acting lipoglycopeptides have been evaluated as primary and secondary treatments of serious Gram-positive infections. Providers may be motivated to prescribe these agents more often based on unfavorable patient-specific characteristics and to facilitate early hospital discharge. Careful clinical consideration is warranted to optimize treatment success and limit inappropriate use of these novel medications.