Dalbavancin !
A long-acting lipoglycopeptide for gram-positive skin infections, including MRSA, given as one or two infusions.
Updated 2026-11-01
No dalbavancin-bound structure is available; the figure shows vancomycin, its parent glycopeptide, holding the same D-Ala-D-Ala peptide.
Mechanism of action
Dalbavancin binds the D-alanyl–D-alanine end of the stem peptide of the nascent cell wall and prevents cross-linking, like vancomycin. Its lipid side chain anchors it in the bacterial membrane and it forms dimers, which increase binding and potency. It is bactericidal against staphylococci (including MRSA) and streptococci; enterococci with the vanA gene are often resistant.
- The lipid tail anchors it in the bacterial membrane
- Binds the D-Ala–D-Ala end of the wall precursor
- Cross-linking stops and the bacterium dies
Pharmacokinetics
- Absorption
- Intravenous only.
- Distribution
- About 93% bound to albumin; reaches skin and bone, very little enters the cerebrospinal fluid.
- Elimination
- Slowly, partly unchanged in the urine and partly in the faeces.
- Half-life
- Very long: the effective half-life is about 8.5 days, which allows single-dose or weekly treatment.
Indications
- Acute bacterial skin and skin-structure infections by gram-positives, including MRSA. Cellulitis of the leg →
- Skin abscesses within those infections. Abscess, furuncle and carbuncle →
Adverse effects
Common
- Nausea, headache, diarrhoea
- Infusion reactions with fast infusion: upper-body flushing, urticaria, itching, back pain
Contraindications
- Known hypersensitivity to dalbavancin
- Caution in patients with hypersensitivity to other glycopeptides
Key interactions
- Other glycopeptides (vancomycin)
- Possible cross-hypersensitivity; the allergy history is reviewed.
What is monitored
- Signs of allergy during and after the infusion
- Liver tests if symptoms appear
- Clinical response of the skin infection
Administration and safety
- Reconstituted gently to avoid foaming and given as an IV infusion over the set time; fast infusion causes flushing and itching.
- If an infusion reaction appears, the infusion is slowed or stopped.
Nursing care
- Ask about allergy to vancomycin or other glycopeptides before the dose.
- Monitor the patient during the infusion for flushing, rash or breathing problems.
- Teaching: the drug stays in the body for weeks; report rash, swelling or diarrhoea even after discharge.
Pregnancy and breastfeeding
Human data are limited; the pregnancy is reported to the treating team, and the drug is used only if the benefit justifies it.
Test yourself
Think of the answer, then tap the question to see it.
Why can dalbavancin treat a skin infection with one or two doses?
It is highly protein-bound and has an effective half-life of about 8.5 days.
What structural feature separates dalbavancin from vancomycin?
A lipid side chain that anchors it in the bacterial membrane and helps it dimerize, increasing potency.
Which enterococci are often resistant to dalbavancin?
Those carrying the vanA gene, which changes the D-Ala–D-Ala target.
Related drugs
Related conditions
← Back to the class: Glycopeptides
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: DailyMed - DALBAVANCIN injection, powder, lyophilized, for solution (DailyMed (U.S. National Library of Medicine), 2026); Dalbavancin Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 58 (McGraw Hill, 2023); RCSB PDB - 1FVM: Complex of vancomycin with DI-acetyl-LYS-D-ALA-D-ALA (RCSB Protein Data Bank, 2026).
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Representative model, for educational purposes only.