dalbavancin

General

Pronunciation:
dal-ba-van-sin


Trade Name(s)

  • Dalvance

Ther. Class.
anti-infectives

Pharm. Class.
lipoglycopeptides

Indications

Treatment of skin/skin structure infections due to susceptible bacteria.

Action

Binds to bacterial cell wall resulting in cell death.

Therapeutic Effect(s):

Bactericidal action against susceptible bacteria with resolution of infection.

Spectrum:

Active against Staphylococcus aureus (including methicillin-susceptible and resistant strains), Streptococcus agalactiae, Streptococcus anginosus (including S. anginosus, S. intermidius and S. constellatus) and Streptococcus pyogenes.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.

Distribution: Penetrates tissues and fluids.

Metabolism and Excretion: 33% eliminated unchanged in urine, 12% eliminated as inactive metabolite, 20% excreted in feces.

Half-life: 346 hr.

TIME/ACTION PROFILE (blood levels)

ROUTEONSETPEAKDURATION
IVunknownend of infusion1 wk

Contraindication/Precautions

Contraindicated in:

  • Hypersensitivity.

Use Cautiously in:

  • Renal impairment (dose adjustment required for CCr <30 mL/min;
  • Moderate to severe hepatic impairment;
  • Geri: Consider age-related decrease in renal function;
  • OB: Use during pregnancy only if potential benefit justifies potential risk to the fetus;
  • Lactation: Use cautiously if breast feeding;
  • Pedi: Safe and effective use in children has not been established.

Adverse Reactions/Side Effects

CNS: headache

GI: DIARRHEA INCLUDING CLOSTRIDIUM DIFFICILE, ↑ ALT, nausea

Derm: pruritus, rash

Misc: HYPERSENSITIVITY REACTIONS INCLUDING ANAPHYLAXIS, infusion reactions including Red-Man Syndrome

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

None noted.

Route/Dosage

IV: (Adults) 1500 mg once or 1000 mg followed 1 wk later by 500 mg.

Renal Impairment
IV: (Adults) CCr <30 mL/min–1125 mg once or 750 mg followed 1 wk later by 375 mg.

Availability

Lyophylized powder for intravenous injection: 500 mg/vial

Assessment

  • Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and during therapy.
  • Obtain specimens for culture and sensitivity prior to therapy. First dose may be given before receiving results.
  • Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of Clostridium difficile-associated diarrhea (CDAD). May begin up to 2 mo following cessation of therapy.
  • Monitor for infusion reactions (Red-man syndrome –flushing of upper body, urticaria, pruritus, rash). May resolve with stopping or slowing infusion.

Lab Test Considerations:

Monitor hepatic function tests. May cause ↑ ALT, AST, and bilirubin.

Potential Diagnoses

Implementation

IV Administration

  • Intermittent Infusion: Reconstitute with 25 mL of Sterile water or D5W in each 500 mg vial. Alternate gentle swirling and inverting to avoid foaming, until completely dissolved. Do not shake. Reconstituted vial contains a clear colorless to yellow solution. Do not administer solutions that are discolored or contain particulate matter. Transfer reconstituted solution into D5W. Concentration: 1 mg/mL to 5 mg/mL. Discard unused solution. May be refrigerated or kept at room temperature; do not freeze. Infuse within 48 hr of reconstitution. Do not administer solutions containing particulate matter.
  • Rate:Infuse over 30 min.
  • Y-Site Incompatibility: Do not infuse with other medications or electrolytes. Saline solutions may cause precipitation. Flush line before and after infusion with D5W.

Patient/Family Teaching

  • Instruct patient to notify health care professional if signs and symptoms of hypersensitivity reactions (rash, hives, dyspnea, facial swelling) occur.
  • Instruct patient to notify health care professional immediately if diarrhea, abdominal cramping, fever, or bloody stools occur and not to treat with antidiarrheals without consulting health care professionals
  • Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
  • Advise female patients to use effective contraception during therapy and to notify health care professional if pregnancy is suspected or if breast feeding.
  • Instruct the patient to notify health care professional if symptoms do not improve.

Evaluation/Desired Outcomes

Resolution of the signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.

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