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Dalbavancin works as secondary therapy for S. aureus in patients who use drugs

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February 9, 2019

Chloe Bryson-Cahn, MD
Chloe Bryson-Cahn

A study evaluating the use of dalbavancin as secondary therapy for serious Staphylococcus aureus infections in people who use drugs found that most patients experienced clinical response to the treatment, according to research published in Open Forum Infectious Diseases.

“This study supports the use of dalbavancin as a secondary therapeutic option for serious Staphylococcus aureus infections in people who use drugs in whom creating a safe and feasible treatment course can be challenging,” Chloe Bryson-Cahn, MD, assistant professor of allergy and infectious diseases at the University of Washington School of Medicine, told Infectious Disease News.

Bryson-Cahn and colleagues retrospectively reviewed 32 cases of off-label dalbavancin use for treatment of serious S. aureus infections in people who use drugs, including endocarditis, osteomyelitis, septic thrombophlebitis and epidural infection. The study was conducted at Harborview Medical Center in Seattle.

The researchers noted that dalbavancin was added to the hospital’s formulary in 2015 with a restriction that requires approval from the infectious disease team, antimicrobial stewardship and the outpatient parenteral antimicrobial therapy program. In May 2014, the FDA approved dalbavancin for adults with serious skin infections caused by certain gram-positive organisms.

Patients in the study were aged 18 years or older (average age, 38 years), had been hospitalized between June 1, 2015, and Sept. 30, 2017, received initial antibiotic treatment and were discharged on dalbavancin as secondary treatment. The patients received the initial infusion of dalbavancin over 30 minutes on the day of discharge, with therapy duration determined by the consulting infectious disease physician. The patients received an average of 13 days of antibiotic therapy before dalbavancin administration, Bryson-Cahn noted.

The majority of patients were male (72%), white (88%), and classified as people who inject drugs (88%). Eighty-eight percent of the infections were due to MRSA, and 81% of the isolates were fluoroquinolone resistant.

A clinical response to treatment was documented in 56% of patients, and only 13% experienced a clinical failure, according to the researchers. The other 31% of patients were not evaluated because they were lost to follow-up.

Nineteen percent of the patients were readmitted to the hospital within 30 days of discharge. However, none were readmitted for adverse effects related to dalbavancin.

“Additional studies that employ innovative strategies to keep these hard-to-engage patients in care long enough to complete dalbavancin or alternative treatments are needed to validate this treatment strategy,” Bryson-Cahn and colleagues wrote. – by Bruce Thiel

Disclosures: Infectious Disease News was unable to determine the authors’ relevant financial disclosures prior to publication.

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