At a glance

What are dalbavancin, oritavancin, and telavancin?

Dalbavancin (Dalvance), oritavancin (Orbactiv, also Kimyrsa), and telavancin (Vibativ) are lipoglycopeptide antibiotics, semi-synthetic molecules built on the glycopeptide backbone of vancomycin with an added lipid side chain. That modification extends how long they last in the body and, for two of them, adds a second way of attacking bacteria. All three are active against Gram-positive organisms including MRSA. They were approved in the United States between 2009 (telavancin) and 2014 (dalbavancin and oritavancin).

How do they work?

Like vancomycin, these drugs block bacterial cell-wall synthesis by binding the D-alanyl-D-alanine end of the wall's building blocks, preventing the cross-linking that gives the wall strength. The lipid tail anchors them in the bacterial membrane, which both prolongs their activity and, in the case of oritavancin and telavancin, lets them also disrupt the membrane itself, a second bactericidal mechanism. All are bactericidal against Gram-positive bacteria including MRSA.

The standout practical feature is duration. Dalbavancin's half-life of roughly two weeks allows a once-weekly or even single-dose regimen, and oritavancin treats a skin infection with a single infusion. In its pivotal program, once-weekly dalbavancin was non-inferior¹ to a conventional vancomycin-to-linezolid course for skin infections. Telavancin is dosed daily and has a broader approved role that includes some pneumonia.

Is it FDA-approved?

Yes. All three are approved for acute bacterial skin and skin-structure infections. The table shows when each was approved and for what:

Telavancin carries boxed warnings for kidney toxicity and for fetal risk, requiring a pregnancy test before use.

What are they prescribed for?

These drugs are prescribed for acute bacterial skin and skin-structure infections caused by susceptible Gram-positive bacteria, including MRSA. Dalbavancin and oritavancin are often chosen when a very short or single-dose course is advantageous, such as avoiding a prolonged IV line. Telavancin is also used for certain hospital-acquired pneumonias when other options are not appropriate.

What are the side effects?

According to the prescribing information, common side effects include:

• Nausea, headache, and diarrhea
• Rises in liver enzymes (dalbavancin)
• Taste disturbance and foamy urine (telavancin)

More serious considerations include:

• Telavancin's boxed warnings for kidney toxicity (with higher mortality in pneumonia patients who already have moderate-to-severe kidney impairment) and for fetal harm
• Oritavancin interferes with some blood-clotting tests and should not be used with intravenous unfractionated heparin for a period after dosing
• Infusion-related reactions

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