This text and table is intended for use as a study tool to assist people learning antimicrobial pharmacotherapy of oritavancin and dalbavancin. Perspective on their potential roles in clinical practice and additional resources are also provided.
You can see how well you know these two drugs with this quick 5-question quiz here.
Authored by: Timothy P. Gauthier, Pharm.D., BCPS-AQ ID & Monica V. Mahoney, Pham.D., BCPS-AQ ID
[Last updated: 1 December 2017]
Dalbavancin (Dalvance) and oritavancin (Orbactiv) are antibiotics with long half-lives which allow for extraordinarily infrequent dosing. Both drugs were FDA- approved in 2014 for acute bacterial skin and skin structure infections, providing novel options for infections caused by resistant Gram positive organisms such as methicillin-resistant Staphylococcus aureus (MRSA).
The role of dalbavancin and oritavancin in clinical practice continues to evolve. For one, their hefty price tag has caused many clinicians to think twice before pulling the trigger on prescribing them. In addition, clinical data for indications beyond the FDA-approvals continues to trickle in, suggesting broader future application.
These drugs are relatively new to the market and not as widely used as some of our other antibiotics. It is likely that people are still trying to learn about their nuances and there is no doubt trainees will be looking to get a handle on some of the basics. In an effort to assist with this process, we have composed the following study table to help compare dalbavancin versus oritavancin.
The information in this comparison includes some of the most common considerations to be aware of in clinical practice. Readers are cautioned that: (1) this is not a complete review of these two agents, (2) some of what is presented is based upon the opinion of the authors, and (3) this is not a replacement for sound clinical judgment. This is provided for study purposes only.
Comparison of dalbavancin versus oritavancin
|
Dalbavancin |
Oritavancin |
|
| Brand name |
Dalvance |
Orbactiv |
| Generic available |
No |
No |
| Manufacturer |
Durata Therapeutics |
The Medicines Company (now Melinta Therapeutics) |
| Drug class |
Lipoglycopeptide |
Lipoglycopeptide |
| FDA-approval |
May 2014 |
August 2014 |
| Mechanism of action |
Interferes with the carboxyl terminal D-alanyl-D-alanine residue terminus of the stem pentapeptide in nascent cell wall peptidoglycan, thus preventing cross-linking |
1. Inhibits transglycosylation (polymerization) by binding to stem peptides of peptidoglycan precursors; 2. Inhibits cell wall transpeptidation (crosslinking) by binding to the peptide bridging segments of the cell wall; 3. Disruption of bacterial cell membrane integrity, leading to depolarization, permeabilization, and cell death |
| Type of killing |
Concentration-dependent |
Concentration-dependent |
| Type of activity |
Bactericidal |
Bactericidal |
| Half-life |
346 hours |
245 hours |
| FDA-approved indication for acute bacterial skin and skin structure infections |
Yes |
Yes |
| Streptococcal activity |
Yes |
Yes |
| Staphylococcal activity |
Yes |
Yes |
| MRSA activity |
Yes |
Yes |
| VRSA activity |
Poor |
Yes |
| Enterococcal activity |
Yes |
Yes |
| VRE activity |
VanA carrying strains no, but VanB carrying strains yes |
Can potentially work for VanA or VanB carrying strains |
| Gram negative activity |
No |
No |
| Atypical activity |
No |
No |
| Anaerobic activity |
No |
No |
| Available oral |
No |
No |
| Available injectable |
Yes |
Yes |
| Usual regimen* |
Regimen 1: 1,500mg once or Regimen 2: 1,000mg once followed by 500mg once 7 days later |
1,200mg once |
| Renal adjustment |
Yes (CrCl < 30 mL/min) |
No |
| Hepatic adjustment |
Use caution in moderate to severe hepatic dysfunction |
Use caution in moderate to severe hepatic dysfunction |
| Infusion time |
30 minutes |
3 hours |
| Potential for red man syndrome |
Yes |
Yes |
| Notable toxicities to beware |
Hypersensitivity reactions, infusion reactions, hepatic effects, hypotension, hypokalemia |
Hypersensitivity reactions, infusion reactions, headache, nausea, vomiting |
| Typical baseline lab monitoring |
CBC, CMP |
CBC, CMP |
| FDA boxed warnings |
None |
None |
| Major drug-drug interactions |
No |
Warfarin; some CYP substrates, inhibitors, and inducers |
| Drug-lab interactions |
No |
aPTT, ACT |
| Cost |
Expensive |
Expensive |
*Refers to adults
Abbreviations: ACT = activated clotting time; aPTT = activated partial thromboplastin time; CBC = complete blood count; CMP = comprehensive metabolic panel; CrCl = creatinine clearance; CYP = cytochrome P450; FDA = Food and Drug Administration; MRSA = methicillin-susceptible Staphylococcus aureus; VRE = vancomycin-resistant Enterococci; VRSA: vancomycin-resistant Staphylococcus aureus
What is red man syndrome?
Red man syndrome aka “red person syndrome” aka “red neck syndrome” results from infusing certain types of medications too rapidly, which causes the body to release histamine and in turn causes the skin to turn red. Red man syndrome is not an allergy, but drugs that cause red man syndrome can also cause hypersensitivity reactions. Typically when people talk about red man syndrome, they are talking about vancomycin, but other drugs besides vancomycin (e.g., ortivancin, dalbavancin) can cause red man syndrome too. It is common that red man syndrome can be managed with antihistamines and slowing infusion rates.
Recommended Readings
- Single-Dose Dalbavancin: A Review in Acute Bacterial Skin and Skin Structure Infections (Drugs 2017)
- Dalbavancin and Oritavancin: An Innovative Approach to the Treatment of Gram-Positive Infections (Pharmacother 2015)
- Dalbavancin for the treatment of acute bacterial skin and skin structure infections (Expert Opin Pharmacother 2015)
- Oritavancin: A Long-Half-Life Lipoglycopeptide (Clin Infect Dis 2016)
- Oritavancin, a single-dose, complete regimen, for the treatment of acute bacterial skin and skin structure infections (Expert Rev Antiinfect Ther 2015)
- Oritavancin: a review in acute bacterial skin and skin structure infections (Drugs 2015)
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