Specifying Targeted Antibiotic Treatment Options for Spinal Implant Infections

We read with great interest the narrative review by Tai et al. [1] on the current state of the art in the diagnosis and management of spinal implant infections.This review is filling an essential gap in a clinically highly relevant topic lacking dedicated guidelines.However, we believe that certain aspects of treatment decisions require further clarification, particularly in relation to infections caused by gram-positive organisms.The discussion on intravenous treatment options for infections caused by Staphylococcus species or Enterococcus species, mentions dalbavancin (Table 1).Available evidence suggests that two 1500 mg doses given one week apart provide sufficient dalbavancin exposure for 8 weeks [2][3][4].Therefore, a third dose of 1500 mg might be appropriate to cover 12 weeks of therapy.Could the authors elaborate on the reasoning behind their recommended regimen of 1500 mg every two weeks?Understanding the basis for this recommendation is crucial, particularly given the significant cost implications of the proposed 12-week regimen (totaling 9000 mg of dalbavancin) compared to the alternative 3000 mg outlined in the package insert (1500 mg on day 1 and day 8), which has been shown to maintain pharmacokinetic/pharmacodynamic efficacy thresholds for staphylococcal osteoarticular infections for 5-6 weeks[5], necessitating a third 1500 mg dose at