Pharmacy and Therapeutics - January 2008 - (Page 50) DRUG FORECAST continued from page 45 Table 4 Adverse Drug Events in a Study of Catheter-Related Bloodstream Infections with Dalbavancin and Vancomycin Adverse Event Hypotension Hypokalemia Constipation Dyspnea Oral candidiasis Diarrhea Anemia Vomiting Pleural effusion Dalbavancin (%) 21.2 18.2 18.2 15.2 12.1 21.2 18.2 6.1 3 Vancomycin (%) 5.9 0 11.8 2.9 8.8 11.8 11.8 20.6 11.8 12. 13. 14. Data from Raad I, Darouiche R,Vazquez J, et al. Clin Infect Dis 2005;40:374–380.38 15. CONCLUSION Dalbavancin is a unique second-generation glycopeptide with in vitro activity against gram-positive organisms, including resistant organisms such as MRSA and some VRE strains. It is not active against gram-negative pathogens or VanA genes containing Enterococcus spp. A New Drug Application for dalbavancin was filed with the FDA in 2005, and the medication is currently being studied for the treatment of gram-positive complicated and uncomplicated SSTIs in phase 3 trials and for catheter-related bacteremia in phase 2 clinical trials. An approvable letter was issued in 2006. With its long half-life of six to 10 days, dalbavancin can be administered as a once-weekly IV infusion; this feature is especially beneficial for the long-term treatment required in some gram-positive infections. Reported adverse events have been mild and comparable to those associated with other gram-positive antimicrobial agents such as vancomycin and linezolid. To date, no renal adjustments or CYP 450 drug interactions have been reported for dalbavancin, and no nephrotoxic or ototoxic concerns exist with dalbavancin treatment, as is the case with vancomycin. Clinically, laboratory drug level monitoring is not required for dalbavancin, a considerable advantage over vanco mycin. So far, dalbavancin is an effective and well-tolerated antimicrobial option for gram-positive infections. Additional clinical research is needed to place this antibiotic agent among other powerful weapons against gram-positive resistant organisms. REFERENCES 1. Shurland S, Zhan M, Bradham DD, Roghmann MC. Comparison of mortality risk associated with bacteremia due to methicillin-resistant and methicillin-susceptible Staphylococcus aureus. Infect Control Hosp Epidemiol 2007;28:273–279. 2. Lowy FD. Staphylococcus aureus infections. N Engl J Med 1998;339:520–532. 3. Chang WN, Lu CH, Wu JJ, et al. Staphylococcus aureus meningitis in adults: A clinical comparison of infections caused by methicillin-resistant and methicillinsensitive strains. Infection 2001;29:245– 250. 4. Wilson WR, Karchmer AW, Dajani AS, et al. 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