The emergence of long-acting glycopeptides provides opportunities for studies of their use in creative ways to adequately treat complicated infections due to gram-positive pathogens like Staphylococcus aureus. Complicated S. aureus bacteremia has historically been treated with extended courses of intravenous therapy. While there have been studies of transitioning to oral therapy for conditions like osteomyelitis and endocarditis, the relative lack of patients with methicillin-resistant S. aureus infections in trials like POET and OVIVA has raised concern. Hence, long-acting glycopeptides are potentially attractive options, especially for patients that may have barriers to extended intravenous therapy.
Researchers at 23 North American medical centers recently published in JAMA a study that randomized 200 patients with complicated S. aureus bacteremia who had been treated with three to 10 days of standard intravenous therapy to finish targeted standard therapy for a total of four to eight weeks or to receive two doses of dalbavancin 1,500 mg intravenously seven days apart. The analysis relied upon desirability of outcome ranking a combination of clinical failure, infectious complications, adverse events and death. While the dalbavancin arm did not achieve superiority (the goal of the trial), outcomes were similar between the two groups, with clinical efficacy 73% for dalbavancin and 72% for standard therapy. Treatment-related adverse events were uncommon.
This study supports the notion that dalbavancin can be considered as an option to complete treatment for complicated S. aureus bacteremia. The desirability of outcome ranking did not include considerations for quality-of-life factors such as ability to discharge home without an intravenous catheter (and lower risk of thrombosis as a result), which can be important considerations even in the absence of barriers to home intravenous therapy.
(Turner et al. JAMA. 2025;334;(10):866-877. Published online: Aug. 13, 2025.)