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A Study Table To Help You Compare Dalbavancin Versus Oritavancin

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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Filed Under: Infectious Diseases & Antimicrobial Stewardship

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