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Dalbavancin – ADVANCE-ing Treatment of Soft Tissue Infections?

November 10, 2021

Written by Megan Hilbert

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The ADVANCE trial showed significant reduction in hospitalization rates solely for IV antibiotics in patients with uncomplicated mild to moderate skin infections.

Why does this matter?
IV antibiotic administration is the only reason for hospital admission for approximately 40% of patients with uncomplicated skin and soft tissue infections (SSTIs). In a system that is already stressed, dalbavancin administration and discharge could decrease health care utilization and improve patient satisfaction. But does it work?

Dalbavancin is a novel second-generation lipoglycopeptide antibiotic belonging to the same class as vancomycin. This medication reaches steady state after 3 days and has a half-life of 8.5 days making it ideal for outpatient management of soft tissue infections.

The ADVANCE trial was a superiority study in which 11 US academically affiliated EDs served as their own control with implementation of usual care (“pre-intervention” – vancomycin, cefazolin, or ceftriaxone and admission) and clinical pathway (“post-intervention” – dalbavancin and discharge). The primary outcome was rate of initial hospitalization, and dalbavancin was associated with significant reduction (50%). With regard to secondary outcomes, this study demonstrated decreased healthcare utilization, similar adverse events, and improvement of patient satisfaction with the intervention group as well.

This study suggests that a “treat and street” option is an option for uncomplicated SSTIs that otherwise would have been admitted for IV antibiotics alone.

The most important side note of this study is the fact that dalbavancin was provided free of charge; further cost-analyses are needed to make sure that this pathway decreases overall healthcare costs.

Editor’s note: Thankfully, we have a cost analysis of dalbavancin on deck for tomorrow! Spoiler alert – it’s not cheap. ~Clay Smith

Pathway with single-dose long-acting intravenous antibiotic reduces emergency department hospitalizations of patients with skin infections. Acad Emerg Med. 2021 Oct;28(10):1108-1117. doi: 10.1111/acem.14258. Epub 2021 May 5.

What are your thoughts?