Effectiveness and safety of dalbavancin off label treatment during pandemic

ABSTRACT

Background: Dalbavancin is a lipoglycopeptide antibiotic approved for treatment of acute bacterial skin infection by GRAM +, also used for his long half-life in bone infection. Case Report A 72 years old patient was admitted to hospital with low-grade fever for 40 days and back pain after two hospitalization for COVID19 infection and ischemic stroke. Blood examinations showed elevated white blood cells count, increased inflammatory markers and anemia. CT showed bilateral pleural effusion, MRI configured vertebral alteration (D7-D9) suggesting infectious spondylodiscitis, blood and pleural liquid culture evidenced Staphylococcus Aureus MSSA. Levoxacin 500mg2/day and linezolid 600mg2/day IV were started with clinical improvement. Following the patient request, he was discharged with oral Linezolid. Two weeks later he showed worsening back pain and high inflammatory index. Levoxacin 500mg and Rifampicin 600mg were administered 2/day, soon Rifampicin substituted with Minocycline 100mg/day for side effect onset. After 4 week, MRI confirmed worsening of inflammatory state. Based on proven efficacy, Dalbavancin 1500mg/day IV on day 1 and 8 was started, with Minocycline for 24 week, with significant improvement in followup MRI;pleural effusion and inflammatory markers decreased. Conclusions: This case shows high efficacy of dalbavancin in spondylodiscitis pyogenic infection and pleural empyema, avoiding complications and high cost of long-term hospitalization during pandemic. In particular condition the use off label of dalbavancin is a safe and cost effective treatment.