Real world use of dalbavancin for bone and joint infections: a retrospective case series in adults and children

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BACKGROUND: Bone and joint infections (BJIs) often require prolonged parenteral therapy, with challenges of hospitalization and vascular access [1–4]. Dalbavancin, a long-acting lipoglycopeptide, enables once-weekly dosing [7–10]. This study reports real-world outcomes of dalbavancin, used off-label in adults and children with BJIs. METHODS: We conducted a retrospective, single-centre case series of 14 consecutive patients (10 adults, 4 paediatric) with Gram-positive BJIs treated between January 2024 and April 2025. All received ≥ 3 weekly dalbavancin doses (definitive therapy), with oral step-down to complete a total treatment course of 8–12 weeks. Demographics, microbiology, therapy and outcomes were assessed with ≥ 6 months follow-up. MICs were tested using E-test strips; results interpreted using CLSI 2021 breakpoints [12]. Off-label nature of therapy was noted. RESULTS: Median age was 36 years (range 5–80), including 4 paediatric patients. MRSA accounted for 57% of the isolates. Dalbavancin MICs were consistently low (≤ 0.064 mg/L) [12, 14]. Median prior antibiotic exposure was 10 days before switch over to dalbavancin. All patients achieved end-of-therapy cure defined as the resolution of signs and symptoms of infection with no requirement for additional antibiotics for the primary infection and no recurrence. At 6 months, 92.9% patients remained infection-free while one patient who was still under follow up, showed sustained clinical improvement. Therapy was well tolerated with only two mild, self-limiting adverse events but all paediatric patients tolerated therapy well with no adverse events. CONCLUSION: Dalbavancin, used off-label, demonstrated high level of efficacy, tolerability and outpatient feasibility in this small consecutive cohort, supporting its potential role as a treatment option for complex BJIs, including paediatric and bacteraemia-associated cases. Its pharmacokinetics enable streamlined therapy and reduced healthcare utilisation, supporting its role as a valuable therapeutic option for outpatient parenteral therapy [17-19, 21].

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