ARMC ED Dalbavancin Protocol  

FDA Indication: Skin and soft tissue infection (SSTI) 

Off-label uses: Osteomyelitis, septic arthritis, prosthetic joint infection (PJI), bacteremia, endocarditis 

ARMC indication in the ED: SSTI 

Inclusion Criteria 

• Infection is highly suspected or known to be caused by a gram-positive bacteria (Staphylococcus aureus, coagulase-negative Staphylococcus [CoNS], Streptococcus spp., Enterococcus spp.) 

• Cellulitis with erythema size ≥ 75 cm²

  • • Size is measured by the ellipse formula: (0.25 * π * L * W)

    • For reference, 75 cm² is approximately the size of the iPhone 5 

• Ineligible for oral antibiotics by meeting any of the following:

  • • Severity of infection

    • Medication adherence issues

    • Cannot absorb oral antibiotics

    • No oral antibiotic options based on AST results or allergies

    • Failed previous course of oral antibiotics which were started ≤ 7 days ago 

• Approval by ID or Antimicrobial Stewardship Program (ASP) on weekdays from 8 AM – 5 PM; approval by ED pharmacist (03482) after hours or weekends/holidays 

• Able to follow up with ED or jail in 48-72 hours 

Exclusion Criteria 

• History of hypersensitivity reaction to glycopeptide or lipoglycopeptide antibiotics (vancomycin, dalbavancin, telavancin, oritavancin) 

• Severe sepsis or septic shock 

• Infection potentially caused by gram-negative bacteria. Examples include necrotizing fasciitis, surgical site infections (SSIs), diabetic foot infections (DFIs), sacral ulcer infections, perineal/perirectal infections, facial infections, animal/human bites, penetrating trauma, and prior gram-negative infection at the same site 

• Known or suspected osteomyelitis or septic arthritis 

• Injection drug use with fever 

• Immunocompromised patients 

• Plans for surgery or other intervention anticipated after ED care 

Workflow 

• Obtain authorization

  • • Weekdays from 8 AM – 5 PM: Message the “Antimicrobial Stewardship Program (ASP) group” via EPIC Secure Chat. This is found under “Groups” and not “People.” Alternatively, page the on-call ID physician

    • After hours or weekends/holidays: Contact the ED Pharmacist (03482)

• Mark the borders of erythema and take a photo under the EPIC “Media” tab 

• If applicable, perform I&D and obtain wound cultures from pus 

• Order Dalbavancin

  • • CrCl ≥ 30 or on HD: 1500 mg x 1

    • CrCl < 30 and not on HD: 1125 mg x 1 

• Obtain blood cultures only if the patient meets sepsis criteria 

• Establish follow up with ED or jail in 48-72 hours