Experience of longer-term use of dalbavancin in the OPAT setting - Posters

Sep 29, 2026

Background explains dalbavancin as a long-acting second-generation lipoglycopeptide with strong Gram-positive activity and good penetration, making it attractive for OPAT. Three OPAT cases describe longer-term, largely off-label use: an aortic graft infection managed palliatively, enterococcal endocarditis switching after C. difficile, and chronic knee replacement infection suppression. Outcomes report tolerability, no breakthrough infection or re-admissions, while the optimal long-term dosing strategy remains unclear and therapeutic drug monitoring is suggested.

LanguageEnglish

CategoryHealthcare

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Reading Time5 min

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Background

Case 1

Case 2

Case 3

Conclusions

Posters Abstract citation ID: dlaf239.021 P17 Experience of longer-term use of dalbavancin in the OPAT setting Joseph Suich1, Joanne Delahay1, Sally O’Neill1, Hayleigh Cutler1, Stephanie Fussey1, Cameron Bowen1, Chloe Walsh1 1Hull Teaching Hospitals NHS Trust, Hull, UK Background: Dalbavancin represents a novel, second generation lipoglycopeptide. It has excellent activity against Gram-positive organisms, and good penetration into skin structures, synovial ﬂuid and bone tissue. It has a long elimination half-life of 14.4 days, which makes it a uniquely attractive agent for use in the OPAT setting. Dalbavancin is licensed for treatment of acute bacterial skin and skin structure infections with a recommended dosing regimen of 1000 mg one-off dose, and review on Day 8 for consideration of further 500 mg dose, or 1500 mg one-off dose of treatment, considered to give around 14 days effective antibiotic cover. Dalbavancin is increasingly used ‘off label’ to treat deep-seated Gram-positive infections, such as infective endocarditis, vascular graft infections and bone and joint infections. There are also descriptions of dalbavancin use as chronic suppressive therapy. Here we present three cases of longer term dalbavancin use in our OPAT service. Case 1: A78-year-old male patient with an aortic graft infection, with no surgical option for source control. Blood culture samples grew Staphylococcus epidermidis and Escherichia coli 16 months ago. He had previously failed long-term oral suppression with co-trimoxazole alone, being readmitted with breakthrough infection. Dalbavancin alongside co-trimoxazole (for Gram-negative cover) was administered at a dose of 1500mg Day 0, with a further 1500mg Day 8 repeated every 2 months as a palliative management strategy. Treatment has continued for a year so far with no breakthrough infection, thoughthe patient has had areadmission with diverticulitis. Case 2: A 58-year-old male patient with prosthetic valve enterococcal endocarditis. This followed an elective aortic root replacement with mechanical valve conduit 4 years ago. Following initial inpatient therapy, he was given long-term suppression with oral amoxicillin, but developed Clostridioides difﬁcile with persistent diarrhoea. The patient was switched to dalbavancin to give a period of oral therapy to aid C. difﬁcile recovery. He had three courses of dalbavancin (regimen as above) allowing improvement in his diarrhoea before being rechallenged with oral amoxicillin, which he is currently tolerating. Case 3: A 73-year-old male patient with a chronic infected right knee replacement. No recent positive microbiology, but Group G haemolytic Strep. was isolated 5 years ago from a knee joint sinus swab. Following review in the bone and joint clinic, it was recommended that this patient may beneﬁt from further knee surgery, but he declined further surgical management. With no other oral options available, he has received long term suppression with dalbavancin (alternative dosing of 1000 mg every 4 weeks) and is responding well. Conclusions: Dalbavancin is increasingly used outside its licence for treatment of deep-seated infections. Here we describe the successful use of longer-term dalbavancin through OPAT. The dalbavancin was well tolerated and no side effects were Posters reported in our cohort to date. There were no hospital re-admissions related to the original infection. The optimal dosing strategy for long-term use of dalbavancin remains unclear and requires further research. Therapeutic drug monitoring would bea helpful addition to help determine dosing but is not currently available for routine practice in the UK.

FAQs

Why is dalbavancin considered suitable for OPAT?

Dalbavancin has excellent Gram-positive activity, good penetration into relevant tissues, and a long elimination half-life, supporting extended dosing in the OPAT setting.

What were the key features of Case 1 management?

An aortic graft infection without surgical source control was treated with dalbavancin 1500 mg on Day 0 and 1500 mg on Day 8, then repeated every 2 months, with continued treatment and no breakthrough infection so far.

What limitations and next steps are noted in the conclusions?

Long-term use is increasingly reported, but the optimal dosing strategy remains unclear. Therapeutic drug monitoring could help determine dosing but is not currently available for routine UK practice.

Sep 29, 2026

Uploaded by Olivia Brown