Dalbavancin (Xydalba). Severe bacterial infections of the skin: a teicoplanin me-too.

Vancomycin and teicoplanin, two glycopeptides, are intravenous antibiotics of choice for severe cutaneous infections possibly due to Gram-positive bacteria resistant to other antibiotics. Dalbavancin, a new glycopeptide antibiotic closely related to teicoplanin, is authorised in the European Union for intravenous treatment of acute infections of the skin and soft tissues. Dalbavancin has not been assessed in patients with infections resistant to other glycopeptide antibiotics. Dalbavancin was similarly effective to comparator antibiotics, including vancomycin, in five trials including more than 2800 patients. Dalbavancin exposes patients to the same adverse effects as those of other glycopeptides: gastrointestinal disorders (including pseudomembranous colitis); hypersensitivity reactions (including anaphylaxis); cutaneous reactions; anaemia; and, probably, kidney failure. Dalbavancin is partly eliminated by the kidneys and may therefore interact with nephrotoxic drugs. Interactions with transport proteins such as P-glycoprotein have not been studied. Dalbavancin was shown to disrupt embryonic-fetal development in experimental animals. No data on pregnant women are available. The elimination half-life of dalbavancin is more than 10 days, allowing administration in two infusions one week apart. The slow elimination could complicate the management of serious adverse effects, as the drug remains in the body for several weeks. This also makes it more difficult to rapidly adapt treatment to the results of susceptibility tests.