Dalbavancin Disease Interactions

Clostridioides difficile-associated diarrhea (CDAD), formerly pseudomembranous colitis, has been reported with almost all antibacterial drugs and may range from mild diarrhea to fatal colitis. The most common culprits include clindamycin and lincomycin. Antibacterial therapy alters the normal flora of the colon, leading to overgrowth of C difficile, whose toxins A and B contribute to CDAD development. Morbidity and mortality are increased with hypertoxin-producing strains of C difficile; these infections can be resistant to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea after antibacterial use. Since CDAD has been reported to occur more than 2 months after antibacterial use, careful medical history is necessary. Therapy with broad-spectrum antibacterials and other agents with significant antibacterial activity should be administered cautiously in patients with history of gastrointestinal disease, particularly colitis; pseudomembranous colitis (generally characterized by severe, persistent diarrhea and severe abdominal cramps, and sometimes associated with the passage of blood and mucus), if it occurs, may be more severe in these patients and may be associated with flares in underlying disease activity. Antibacterial drugs not directed against C difficile may need to be stopped if CDAD is suspected or confirmed. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C difficile, and surgical evaluation should be started as clinically indicated.

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Therapy with dalbavancin should be administered cautiously in patients with moderate or severe liver dysfunction (Child-Pugh B or C) as no data are available to determine the appropriate dosing in these patients. No dosage adjustment is recommended for patients with mild liver dysfunction (Child-Pugh A).

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The recommended regimen for dalbavancin in patients with CrCl less than 30 mL/min who are not receiving regularly scheduled hemodialysis is 1125 mg as a single dose OR 750 mg once, followed by 375 mg one week later. No dosage adjustment is necessary for patients with CrCl greater than 30 mL/min or for patients receiving regularly scheduled hemodialysis; dalbavancin may be administered without regard to the timing of hemodialysis.

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