Stewarding the Costly Antibiotic: Considerations for Dalbavancin

(See the Major Article by Gonzalez et al on pages e1436–42.) In this issue of Clinical Infectious Diseases, Gonzalez et al discuss the use of the long-acting lipoglycopeptide (LaGP) dalbavancin in the treatment of acute bacterial skin and skin structure infections (ABSSSIs) in the emergency department (ED) [1]. The primary objective was to evaluate total cost of care to the system with dalbavancin compared to standard of care (SoC), which could include either intravenous (IV) or oral therapy. In their retrospective matched cohort of 418 patients, the authors found that dalbavancin administered as a single 1500-mg IV dose in the ED was significantly more costly per patient compared to SoC. On the surface, these results may not be surprising to some. However, there are several valuable considerations in stewarding costly antibiotics from this important work. First, consider the setting and conditions of dalbavancin use in the Gonzalez...