Dalbavancin, oritavancin & telavancin
Dalbavancin, oritavancin and telavancin are lipoglycopeptides, a class made semisynthetically from vancomycin-type glycopeptides by adding a fatty tail. They are intravenous antibiotics for acute skin infections caused by gram-positive bacteria, including MRSA. Telavancin is also approved for certain hospital-acquired pneumonias caused by Staphylococcus aureus4,5,6.
All three are lipoglycopeptides, chemical relatives of vancomycin that interfere with how bacteria assemble their cell wall. Per its label, dalbavancin attaches to the D-Ala-D-Ala tip of the stem pentapeptide in newly forming peptidoglycan, the mesh that makes up the wall, and so blocks cross-linking4. Oritavancin and telavancin also disrupt the bacterial membrane itself, and oritavancin's label credits these combined actions for its concentration-dependent killing5,6. Dalbavancin and oritavancin stay in the body for a very long time, with terminal half-lives of about two weeks and about ten days respectively4,5. That is why a full course needs far fewer infusions than standard vancomycin1,2. Their activity is limited to gram-positive bacteria such as staphylococci and streptococci, so they do not cover infections driven by gram-negative organisms3,4.
Each was studied in large randomized human trials against vancomycin. In DISCOVER 1 and 2, 1,312 patients with acute skin infections received dalbavancin or vancomycin with an optional switch to oral linezolid; early response was about 80% in both groups, and adverse events were less frequent with dalbavancin1.
In SOLO I (954 adults), oritavancin was noninferior to a multi-day vancomycin course on all three efficacy endpoints, with similar results in MRSA infections, though nausea was more common2. In the ATTAIN trials (1,503 patients with gram-positive hospital-acquired pneumonia), telavancin's cure rates were similar to vancomycin's, but rises in serum creatinine were more frequent (16% versus 10%), and in mixed gram-positive and gram-negative infections vancomycin did better3. Telavancin's boxed warning reports higher mortality than vancomycin among pneumonia patients with pre-existing moderate or severe kidney impairment6.
FDA-approved: telavancin (Vibativ, 2009; adults) for complicated skin infections and, when alternatives are unsuitable, Staphylococcus aureus hospital-acquired or ventilator-associated pneumonia6. Dalbavancin (Dalvance, 2014; adults and children) and oritavancin (Orbactiv 2014, Kimyrsa 2021; adults) are approved for acute bacterial skin and skin-structure infections4,5.
Common trial effects were nausea, headache and diarrhea (dalbavancin); headache, nausea, vomiting, limb abscesses and diarrhea (oritavancin); and taste disturbance, nausea, vomiting and foamy urine (telavancin). Fast infusion can cause flushing and itching, and C. difficile diarrhea can follow. Oritavancin and telavancin falsely prolong some clotting tests, so IV unfractionated heparin is contraindicated around their use. Telavancin carries a boxed warning for kidney toxicity, fetal harm seen in animal studies and higher pneumonia mortality with kidney impairment, and can prolong QT4,5,6.
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