Drug reference

Dalbavancin

Lipoglycopeptide antibiotic (long-acting) · Antibiotic

Also known as Xydalba, Dalbavancin hydrochloride

START

1500 mg IV single dose over 30 min

TYPICAL MAX

1500 mg single (or 1000 + 500 mg 1 week apart)

STOP IF

Anaphylaxis or significant hepatotoxicity

WATCH

Infusion rate (reaction), LFTs, CDI symptoms, renal function

CDSCO approvedSchedule HATC J01XA04

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 6min · infusion start
PEAK: 30min · end infusion
t½: 2.1w · t½ ~14 d
DURATION: 2w · single-dose cover

EXCRETION

Renal ~33% unchanged; faecal remainder

route + CYP

INTERACTIONS

—

none in our sources

PREGNANCY

Limited data; use only if clearly needed.

FDA category + note

Mechanism

Binds the D-alanyl-D-alanine terminus of peptidoglycan precursors, inhibiting bacterial cell-wall transglycosylation/transpeptidation; bactericidal against Gram-positive organisms including MRSA, with a very long half-life.

Indications

Acute bacterial skin and skin-structure infections (Gram-positive, including MRSA)

Dosing

Adult: 1500 mg IV single dose over 30 min, OR 1000 mg IV then 500 mg IV one week later.
Pediatric: Weight-based single dose (approved in children; specialist).
Renal adjustment: CrCl <30 and not on haemodialysis: reduce (e.g., 1125 mg single, or 750 mg then 375 mg). No adjustment if on HD.
Hepatic adjustment: Mild: no adjustment; moderate–severe: caution (limited data).
Geriatric: No adjustment beyond renal function.
Max dose: 1500 mg single dose (or 1000 + 500 mg one week apart)

Pharmacokinetics

Onset

Bactericidal levels from end of infusion

Peak effect

End of infusion

Duration

Therapeutic levels for ~1–2 weeks (single dose)

Half-life

~346 h (~14 days)

Bioavailability

IV 100%

Protein binding

~93%

Metabolism

Minimal (hydroxy-dalbavancin minor)

Excretion

Renal (~33% unchanged) and faecal

Contraindications

Hypersensitivity to dalbavancin/glycopeptides
Caution: vancomycin hypersensitivity (possible cross-reaction)

Side effects

Common

NauseaHeadacheDiarrhoeaRashTransient ALT elevation

Serious

Anaphylaxis/serious hypersensitivity
Infusion-related reaction ('red man'-type with rapid infusion)
Hepatotoxicity
Clostridioides difficile colitis

Pregnancy & lactation

Pregnancy

Limited data; use only if clearly needed.

Lactation

Limited data; caution.

Drug interactions

Live Bacterial Vaccines

Moderate

Database

Antibacterial inactivation

Separate appropriately