dalbavancin

dalbavancin

(dal-ba-van-sin ),

Dalvance

(trade name)

Classification

Therapeutic: anti infectives
Pharmacologic: lipoglycopeptides
Pregnancy Category: C

Indications

Treatment of skin/skin structure infections due to susceptible bacteria.

Action

Binds to bacterial cell wall resulting in cell death.

Therapeutic effects

Bactericidal action against susceptible bacteria with resolution of infection.
Active against Staphylococcus aureus (including methicillin-susceptible and resistant strains), Streptococcus agalactiae, Streptococcus anginosus (including S. anginosus, S. intermidius and S. constellatus) and Streptococcus pyogenes.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.
Distribution: Penetrates tissues and fluids.
Metabolism and Excretion: 33% eliminated unchanged in urine, 12% eliminated as inactive metabolite, 20% excreted in feces.
Half-life: 346 hr.

Time/action profile (blood levels)

ROUTEONSETPEAKDURATION
IVunknownend of infusion1 wk

Contraindications/Precautions

Contraindicated in: Hypersensitivity.
Use Cautiously in: Renal impairment (dose adjustment required for CCr <30 mL/min; Moderate to severe hepatic impairment; Geriatric: Consider age-related decrease in renal function; Obstetric: Use during pregnancy only if potential benefit justifies potential risk to the fetus; Lactation: Use cautiously if breastfeeding; Pediatric: Safe and effective use in children has not been established.

Adverse Reactions/Side Effects

Central nervous system

  • headache

Gastrointestinal

  • diarrhea including Clostridium difficile (life-threatening)
  • nausea
  • ↑ ALT

Dermatologic

  • pruritus
  • rash

Miscellaneous

  • hypersensitivity reactions including anaphylaxis (life-threatening)
  • infusion reactions including “Red-Man Syndrome”

Interactions

Drug-Drug interaction

None noted.

Route/Dosage

Intravenous (Adults) 1000 mg followed one wk later by 500 mg.

Renal Impairment

Intravenous (Adults) CCr <30 mL/min—750 mg followed one wk later by 375 mg.

Availability

Lyophylized powder for intravenous injection (requires reconstitution and further dilution): 500 mg single-use vial

Nursing implications

Nursing assessment

  • Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and during therapy.
  • Obtain specimens for culture and sensitivity prior to therapy. First dose may be given before receiving results.
  • Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis. May begin up to 2 mo following cessation of therapy.
  • Monitor for infusion reactions (Red-man syndrome — flushing of upper body, urticaria, pruritus, rash). May resolve with stopping or slowing infusion.
  • Lab Test Considerations: Monitor hepatic function tests. May cause ↑ ALT, AST, and bilirubin.

Potential Nursing Diagnoses

Risk for infection (Indications)
Diarrhea (Adverse Reactions)

Implementation

  • Intravenous Administration
  • Intermittent Infusion: Reconstitute with 25 mL of Sterile water in each 500 mg vial. Alternate gentle swirling and inverting to avoid foaming, until completely dissolved. Do not shake. Reconstituted vial contains a clear colorless to yellow solution. Do not administer solutions that are discolored or contain particulate matter. Transfer reconstituted solution into D5W. Concentration: 1 mg/mL to 5 mg/mL. Discard unused solution. May be refrigerated or kept at room temperature; do not freeze. Infuse within 48 hr of reconstitution. Do not administer solutions containing particulate matter.
  • Rate: Infuse over 30 min.
  • Y-Site Incompatibility: Do not infuse with other medications or electrolytes. Saline solutions may cause precipitation. Flush line before and after infusion with D5W.

Patient/Family Teaching

  • Instruct patient to notify health care professional if signs and symptoms of hypersensitivity reactions (rash, hives, dyspnea, facial swelling) occur.
  • Instruct patient to notify health care professional immediately if diarrhea, abdominal cramping, fever, or bloody stools occur and not to treat with antidiarrheals without consulting health care professionals
  • Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
  • Advise female patients to use effective contraception during therapy and to notify health care professional if pregnancy is suspected or if breastfeeding.
  • Instruct the patient to notify health care professional if symptoms do not improve.

Evaluation/Desired Outcomes

  • Resolution of the signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.
References in periodicals archive ?
CONTRAINDICATIONS DALVANCE is contraindicated in patients with known hypersensitivity to dalbavancin.
They were dalbavancin (Dalvance), approved in May; tedizolid (Sivextro), approved in June; and oritavancin (Orbactiv), approved in August.
There are some promising new therapies in late-stage trials, including Trius Therapeutics' tedizolid and Durata Therapeutics dalbavancin.
Two other lipoglycopeptides, dalbavancin and oritavancin, are not currently available and continue to be studied.
approval of dalbavancin last year after regulators said another trial was needed.
anidulafungin for fungal infections and dalbavancin for Gram-positive
NASDAQ: DRTX) today announced preliminary, top-line results for its DISCOVER 1 ("Dalbavancin for Infections of the Skin COmpared to Vancomycin at an Early Response") Phase 3 study of dalbavancin, which is under investigation for the treatment of acute bacterial skin and skin structure infections (ABSSSI) caused by susceptible gram-positive bacteria, including MRSA (methicillin resistant Staphylococcus aureus).
Single dose treatment with dalbavancin for acute bacterial skin and skin structure infection (poster 785)
Ceftolozane/tazobactam is the 4th antibiotic to be FDA sanctioned in 2014, following approval of dalbavancin (Dalvance), tedizolid (Sivextro ), and oritavancin (Orbactiv).
Two - oritavancin and dalbavancin - are molecularly related to telavancin, which was approved in 2009.
After hearing comments from regulators last week, Pfizer said it decided to conduct an additional late-stage study of dalbavancin and withdraw applications for the product in the United States and Europe.
Vicuron products anidulafungin and dalbavancin under review by U.