Dalbavancin for the Treatment of Prosthetic Joint Infections: A Narrative Review

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.

Use of Dalbavancin in Skin, Bone and Joint Infections: A Real-Life Experience in an Italian Center

“…Prosthetic joint infections are complex infections, due to biofilm formation. Often, these infections require many surgeries, which in some cases do not resolve the associated symptoms [ 22 ]. Several in vitro and in vivo studies have assessed the efficacy of dalbavancin against biofilm formation and eradication [ 22 ].…”

“…Often, these infections require many surgeries, which in some cases do not resolve the associated symptoms [ 22 ]. Several in vitro and in vivo studies have assessed the efficacy of dalbavancin against biofilm formation and eradication [ 22 ]. However, clinical experiences with dalbavancin for treating prosthetic joint infections were represented by a heterogeneous case series with real-world experience, described in a recent review by Buzòn-Martin et al [ 22 ].…”

“…Several in vitro and in vivo studies have assessed the efficacy of dalbavancin against biofilm formation and eradication [ 22 ]. However, clinical experiences with dalbavancin for treating prosthetic joint infections were represented by a heterogeneous case series with real-world experience, described in a recent review by Buzòn-Martin et al [ 22 ]. Three major strategies are reported: to attempt eradication and cure with prosthesis retention and debridement; attempt eradication and cure with prosthesis removal; or prosthesis retention (chronic suppressive antimicrobial therapy).…”

“…Three major strategies are reported: to attempt eradication and cure with prosthesis retention and debridement; attempt eradication and cure with prosthesis removal; or prosthesis retention (chronic suppressive antimicrobial therapy). This review suggests that the best results are achieved in the case when dalbavancin is combined with adequate surgical source control and prosthesis removal [ 12 , 21 , 22 ]. Wunsch et al [ 13 ] reported treatment failure in five patients; this was mainly due to inadequate surgical control of the site of infection.…”

“…In our small sample of patients with prosthetic infections, the number of doses was also very variable (ranging from 1 to 9 doses). In some studies where dalbavancin was used as an immunosuppressive strategy, patients had received up to 20 doses [ 22 ]. It would therefore be necessary to have a standardized dosing schedule in this setting of patients.…”