Comparing two-dose 1500 mg dalbavancin to standard of care in the outpatient treatment of invasive infections

Standard of care (SOC) treatments for invasive Gram-positive infections often involve prolonged intravenous (IV) antibiotic therapy, which can be cumbersome for patients and lead to complications such as thrombosis and line infections. Dalbavancin (DBV), an intravenous lipoglycopeptide antibiotic, offers a potential alternative due to its long terminal half-life, allowing for less frequent administrations and eliminating the need for outpatient parenteral lines. This study aims to compare the efficacy of a two-dose regimen of dalbavancin (DBV; 1500 mg on day 1 and day 8) to the standard of care (SOC) in the outpatient treatment of invasive Gram-positive infections, including bacteremia, prosthetic joint infections (PJI), and osteomyelitis (OM). A single-center, retrospective, observational cohort study was conducted at the East Alabama Medical Center. Adult patients diagnosed with bacteremia, OM, or PJI and discharged with outpatient antibiotic orders between July 2019 and December 2023 were included. Patients received either two-dose DBV or SOC. Clinical success, defined as the absence of infection recurrence and no additional antibiotic therapy within 90 days postdischarge, was the primary outcome. Secondary outcomes included infection recurrence, additional antibiotic use, readmissions, emergency department visits, and mortality. Out of 148 patients, 62 received DBV and 86 received SOC. Clinical success was achieved in 89% of the DBV group and 92% of the SOC group (p = 0.518). Infection-related readmissions were lower in the DBV group (5% versus 19%; p = 0.011). The DBV group had a shorter mean duration of inpatient antibiotics compared with the SOC group (6.5 days versus 10.1 days; p < 0.001). No mortality was observed in either group. The two-dose DBV regimen demonstrated comparable clinical success to SOC. The DBV group had fewer readmissions and fewer ED visits, although the latter did not reach statistical significance. DBV may offer an alternative for outpatient treatment of invasive Gram-positive infections. Further research with larger sample sizes is recommended to validate these findings.