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Dalbavancin similar to vanco+linezolid for acute bacterial skin infections

Clinical Question:
Is dalbavancin (Dalvance) as effective as vancomycin plus linezolid for acute bacterial skin and skin-structure infection?

Bottom Line:
Dalbavancin provides an alternative to vancomycin plus linezolid for the treatment of acute bacterial skin infections. It is dosed once weekly, and was associated with similar cure rates and lower mortality. If subsequent studies show that patients can be safely treated as outpatients with dalbavancin, this very expensive antibiotic may be cost-effective. (LOE = 1b)

Reference:
Boucher HW, Wilcox M, Talbot GH, Puttagunta S, Das AF, Dunne MW. Once-weekly dalbavancin versus daily conventional therapy for skin infection. N Engl J Med 2014;370(23):2169-2179.  [PMID:24897082]

Study Design:
Randomized controlled trial (double-blinded)

Funding:
Industry

Allocation:
Concealed

Setting:
Inpatient (any location)

Synopsis:
These researchers identified patients with acute bacterial skin infection, characterized by either cellulitis, abscess, or wound infection. All had to have at least 75 cm2 of erythema; at least one sign of systemic infection, such as fever or chills; and at least 2 of the following: purulent drainage, fluctuance, heat or localized warmth, tenderness, or swelling/induration. This report actually combines the findings from 2 identically designed clinical trials, with 24% of patients having an abscess, 53% having cellulitis, and 21% having a wound or surgical site infection. The mean age of participants was 50 years and 58% were men. Patients were randomized to receive either intravenous (IV) dalbavancin 1 g on day 1 and 500 mg on day 8, or IV vancomycin (1 g or 15 mg/kg twice daily) for at least 3 days, followed by the option of a change to oral linezolid 600 mg twice daily for a total of 10 to 14 days of therapy. Groups were balanced at the start of the study, and analysis was by intention to treat.The primary outcomes were clinical response at 2 to 3 days and at the end of therapy, and investigator-assessed clinical response at the end of therapy. In each case, noninferiority of dalbavancin to vancomycin plus linezolid was established. Adverse events, including death, were somewhat less common with dalbavancin (0.2% vs 1.1%; P = .03).

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