Treatment of Staphylococcus aureus bacteremia has traditionally required several weeks of intravenous antibiotics. This approach carries medical risks, such as catheter-associated infection or thrombosis, as well as significant social and financial burdens for patients. Dalbavancin, a long-acting intravenous lipoglycopeptide with activity against S. aureus (including MRSA), has been proposed as a more convenient alternative. This study evaluated the efficacy and safety of dalbavancin compared with standard therapy for S. aureus bacteremia.

Two hundred adults were enrolled in this open-label, randomized clinical trial, which was conducted in the United States and Canada. After blood cultures cleared, participants were randomized to complete therapy with dalbavancin (administered on Days 1 and 8) or with standard treatment (cefazolin for MSSA and vancomycin or daptomycin for MRSA).

The primary outcome was the Desirability of Outcome Ranking (DOOR) at Day 70, incorporating five domains: clinical success, infectious complications, safety events, mortality, and health-related quality of life.

Dalbavancin was not superior to standard therapy for treating S. aureus bacteremia, and adverse events were similar between groups. A key strength of this study was the inclusion of people who inject drugs, a population at high risk for S. aureus bacteremia and often underrepresented in trials. A major limitation was that the DOOR metric did not account for important social and economic factors, such as disposition (home versus skilled nursing facility), caregiver burden, or treatment cost.

Key Takeaway: Dalbavancin may be a suitable alternative to traditional therapy for Staphylococcus aureus bacteremia, offering less frequent dosing and a shorter treatment course. Further research is needed to identify which patients benefit most and to evaluate its impact on social and economic factors such as discharge disposition, caregiver burden, and treatment costs.

References

Turner NA, Hamasaki T, Doernberg SB, et al. Dalbavancin for Treatment of Staphylococcus aureus Bacteremia: The DOTS Randomized Clinical Trial. JAMA. 2025;334(10):866–877. doi:10.1001/jama.2025.12543

McCreary EK, Malani PN. New Pathways to Treat Staphylococcus aureus Bacteremia: Connecting the DOTS. JAMA. 2025;334(10):861–863. doi:10.1001/jama.2025.13717