Dalbavancin / Oritavancin / Telavancin
Lipoglycopeptide antibiotics
Also Dalbavancin, Oritavancin, Telavancin, Dalvance, Orbactiv, Kimyrsa
- Evidence
- AStrong human evidence
- FDA status
- FDA approvedas of 2026-10-26
- Route
- Intravenous
- Studies cited
- 1 human0 animal or cell
Three antibiotics given by drip for serious skin infections. Large trials show they work as well as vancomycin.
Sold for
These antibiotics attract little consumer hype; the clinical interest is in dalbavancin and oritavancin as one- or two-dose treatments that let patients skip a hospital stay or a PICC line.
Studies say
Large randomized trials show once-weekly dalbavancin and single-dose oritavancin match daily vancomycin for skin infections, and telavancin is non-inferior for skin infections and pneumonia, which supports an A for the approved uses.
Why grade A. Each drug was approved on randomized double-blind non-inferiority trials against vancomycin-based standard therapy. The trial in the citations, the pooled DISCOVER 1 and 2 programme for dalbavancin, randomized 1,312 patients and found early clinical response in 79.7% with dalbavancin against 79.8% with vancomycin followed by linezolid. 12
FDA. All three lipoglycopeptides are FDA-approved for skin and skin-structure infections caused by susceptible Gram-positive bacteria: telavancin as Vibativ for complicated skin and skin-structure infections (2009, with hospital-acquired and ventilator-associated pneumonia due to S. aureus added in 2013 when alternatives are unsuitable), dalbavancin as Dalvance (2014, extended to children in 2021) and oritavancin as Orbactiv (2014) and Kimyrsa (2021), both for acute bacterial skin and skin-structure infections. 423
Written from 4 cited sources. Fact-checked 2026-10-27: 22 claims checked, 3 corrected. Last refreshed 2026-10-27. Not physician reviewed.
What this means for you
- What people take it for
- Serious skin infections
- Can a US doctor prescribe it?
- Yes, FDA approved for skin infections caused by certain bacteria.
- Properly tested in people?
- Yes, in large controlled trials; one covered 1,312 patients.
Evidence checklist
- Randomised controlled trial Double-blind trials against vancomycinyes
- Human study over 100 people DISCOVER pooled 1,312 patientsyes
- More than one research group Three drugs, three sponsorsyes
- Clinical outcomes, not surrogate markers Clinical response and mortality measuredyes
- Human safety data beyond case reports Trial and label safety data, boxed warningyes
Drawn from the cited studies below. A dash means the sources give no information.
What it is
Dalbavancin, oritavancin and telavancin are semi-synthetic lipoglycopeptides. These are antibiotics built on the glycopeptide frame of vancomycin or teicoplanin. Each has a fatty (lipophilic) side chain. The side chain anchors the drug in the bacterial membrane. Dalbavancin and oritavancin also bind plasma proteins very tightly. They stay in the body for days to weeks. 234
All three are given only by infusion into a vein. One or two infusions of dalbavancin or oritavancin cover a whole course of treatment. Telavancin is given daily. 234
How it works
Like vancomycin, all three bind the D-alanyl-D-alanine end of the building blocks of the bacterial cell wall. This stops the wall from being cross-linked. The bacterium then bursts under its own pressure. Oritavancin and telavancin add a second action. Their lipid tail inserts into the bacterial membrane and breaks it up. That is why they kill bacteria faster than vancomycin in the lab. It also keeps them working against some vancomycin-resistant strains. The drugs act only on Gram-positive bacteria. These include Staphylococcus aureus (with MRSA) and streptococci. 234
What human research shows
Boucher and colleagues reported DISCOVER 1 and 2. These were two identically designed double-blind, double-dummy randomized trials. They ran at 140 sites in 2011 and 2012. Patients with acute bacterial skin infections got dalbavancin on days 1 and 8. Others got vancomycin by vein for at least three days. They could then switch to oral linezolid. Treatment ran 10 to 14 days. Early response meant two things at 48 to 72 hours. The fever was gone, and the lesion had stopped spreading. It occurred in 525 of 659 dalbavancin patients (79.7%). It occurred in 521 of 653 comparison patients (79.8%). That met the non-inferiority goal. Fewer adverse events were reported with dalbavancin. 1
The oritavancin and telavancin labels summarize their own non-inferiority programs against vancomycin. These were SOLO I and II for oritavancin. For telavancin they were ATLAS in skin infection and ATTAIN in pneumonia. Telavancin's pneumonia approval was limited to patients with no suitable alternative. The reason is that deaths were higher in a subgroup with pre-existing kidney impairment. 34
| Study | Model | Finding |
|---|---|---|
| DISCOVER 1 and 2 (dalbavancin) | Humans, n=1,312, two randomized double-blind non-inferiority trials | Early clinical response 79.7% with two doses of dalbavancin versus 79.8% with vancomycin then linezolid. 1 |
| Orbactiv prescribing information (SOLO trials) | Humans, two randomized double-blind trials versus vancomycin | Single-dose oritavancin non-inferior to 7 to 10 days of vancomycin for skin infections. 3 |
| Vibativ prescribing information (ATLAS and ATTAIN trials) | Humans, randomized double-blind trials versus vancomycin in skin infection and pneumonia | Non-inferior overall; higher mortality in pneumonia patients with pre-existing kidney impairment led to a boxed warning. 4 |
Safety
Dalbavancin and oritavancin are generally well tolerated. Common complaints are nausea, headache and diarrhoea. A fast infusion can cause reactions like vancomycin's red-man syndrome. Oritavancin interferes with blood-clotting tests for days. It must not be used with heparin by vein for 120 hours after a dose. 23
Telavancin carries boxed warnings. One is more deaths than with vancomycin. This was seen in pneumonia patients with moderate to severe pre-existing kidney impairment. Another is new or worsening kidney toxicity. The third is fetal harm in animal studies. So women who could be pregnant must be tested first. Telavancin also causes taste changes and foamy urine. Dalbavancin and oritavancin stay in the body a long time. So stopping the drug will not stop an adverse reaction. 423
Questions for your clinician
- Is a single-dose option suitable for my infection compared with a hospital stay?
- Which of these drugs fits my kidney function?
- Does my infection have a culture showing a susceptible organism?
Questions people ask
Are these antibiotics FDA-approved?
Yes. Telavancin (Vibativ) has been approved since 2009. Dalbavancin (Dalvance) and oritavancin (Orbactiv) have been approved since 2014. A second oritavancin product (Kimyrsa) followed in 2021. All are approved for skin infections. Those are acute bacterial infections for dalbavancin and oritavancin, and complicated ones for telavancin. Telavancin is also approved for certain hospital pneumonias. 423
Why does a single dose work?
Dalbavancin and oritavancin bind plasma proteins so tightly that their half-lives run to a week or more. So one infusion keeps drug levels in tissue above the bacterial kill threshold for the whole course. In the DISCOVER trials, two dalbavancin doses matched 10 to 14 days of daily vancomycin. 123
Do they treat MRSA?
Yes. Methicillin-resistant Staphylococcus aureus is a labeled target for all three. So are methicillin-susceptible strains and streptococci. None of them works on Gram-negative bacteria. 234
What is the biggest safety concern?
For telavancin, the boxed warnings are kidney toxicity and extra deaths. The deaths were in pneumonia patients who already had kidney impairment. For oritavancin, the concerns are blood-clotting tests and heparin, for five days. For all of them, stopping a long-acting drug will not reverse a reaction. 432