Place in therapy of dalbavancin to treat Gram-positive infections in antimicrobial resistance era: an overview

Antimicrobial resistance (AMR) is widespread and represents a current global public health problem, with the forecast of 10 million deaths per year globally by 2050. Antimicrobial resistance surveillance is essential to evaluate the resistance of specific pathogens to different classes of therapeutically relevant antibiotics, to study the spread of antibiotic resistance in the country and to follow its trend over time. Excessive use of antibiotics, long-term treatments and incorrect source control measures are among the main factors influencing the onset of HAIs. For example, overuse of antibiotics in hospital stays during the COVID-19 pandemic led to an accelerated emergence and spread of antibiotic resistance. Interventions aimed at monitoring and guiding the use of antimicrobials in the hospital tend to improve the clinical outcome, reduce the spread of resistant germs and reduce the adverse effects of antibiotics. Acute bacterial skin and skin structure infection (ABSSSI) represent one of the infections, with a great impact on hospitalization and related costs. To optimize economic resources in the healthcare field, the therapeutic approach to the patient with ABSSSI and complicated infections increasingly often involves the early transition from intravenous to oral therapy (early switch) or early discharge with an important impact on hospitalization and consistent savings for the NHS. Real-life experience reports several dalbavancin off-label use in treating Gram-positive infections that usually require long-term intravenous antibiotics including bone and joint infections, bloodstream infections and infective endocarditis. The promising efficacy in these challenging, off-label scenarios makes dalbavancin a viable alternative to daily intravenous or outpatient antimicrobial regimens. The simplified single or weekly administration regimen allows an early discharge, especially when adherence to oral therapy cannot be guaranteed or no oral choices are available.