Mariani Chiara, Passerini Matteo, Galli Lucia, Covizzi Alice, Colaneri Marta, Offer Martina, Faenzi Margherita, Merli Stefania, Landonio Simona, Fusi Marta, Dolci Alberto, Gori Andrea, Cattaneo Dario
Department of Infectious diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, via GB Grassi 74, Milan, Italy.
Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Via G.B. Grassi 74, 20157 Milan, Italy.
J Bone Jt Infect. 2025 Jul 30;10(4):255-263. doi: 10.5194/jbji-10-255-2025. eCollection 2025.
: Long-term dalbavancin use is increasingly adopted off-label for osteoarticular infections (OAIs), but data on administration timing and long-term effects beyond 12 weeks are scarce. This study evaluated the pharmacological efficacy of proactive therapeutic drug monitoring (TDM) to optimize dalbavancin administration. : This single-center, retrospective study included adult OAI patients treated with doses of dalbavancin from July 2022 to October 2024. Initial doses were given on days 1, 8, and 43. From the third dose onward, and values informed dosing schedules via log-linear regression models, targeting mg L. The primary outcome was the pharmacological efficacy of dalbavancin, assessed by the proportion of patients with mg L and mg L after the third dose. Clinical outcomes and safety data were collected as descriptive data. : A total of 33 patients provided 118 determinations. Pharmacological efficacy was achieved in 93 118 (78.8 %) and 114 118 (96.6 %) determinations for thresholds of mg L and mg L, respectively. Efficacy improved when considering only determinations at the correct timing. A total of 18 (54.5 %) patients are still in treatment, while 11 (33.3 %) completed therapy with clinical success. Three patients experienced a relapse after the end of the treatment, while one patient experienced failure, and no adverse events were reported. : Dalbavancin is a viable option for prolonged OAI management when other therapies are unavailable or high-risk. Proactive TDM effectively supports this approach by ensuring adequate drug exposure while preventing accumulation.
长期使用达巴万星治疗骨关节炎感染(OAI)的情况越来越多地在标签外使用,但关于给药时间和超过12周的长期影响的数据却很少。本研究评估了主动治疗药物监测(TDM)以优化达巴万星给药的药理疗效。 本单中心回顾性研究纳入了2022年7月至2024年10月接受达巴万星治疗的成年OAI患者。初始剂量在第1天、第8天和第43天给予。从第三剂开始,通过对数线性回归模型,根据 和 值确定给药方案,目标浓度为 毫克/升。主要结局是达巴万星的药理疗效,通过第三剂后 毫克/升和 毫克/升患者的比例进行评估。临床结局和安全性数据作为描述性数据收集。 共有33例患者提供了118次 测定值。对于 毫克/升和 毫克/升的阈值,分别有93次(78.8%)和114次(96.6%)测定达到药理疗效。仅考虑正确时间的测定时,疗效有所提高。共有18例(54.5%)患者仍在治疗中,11例(33.3%)完成治疗且临床成功。3例患者在治疗结束后复发,1例患者治疗失败,未报告不良事件。 当其他治疗方法不可用或存在高风险时,达巴万星是延长OAI治疗的可行选择。主动TDM通过确保足够的药物暴露同时防止药物蓄积,有效地支持了这种方法。