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: antibiotics built on the glycopeptide scaffold of vancomycin or teicoplanin with a fatty (lipophilic) side chain attached. The side chain anchors the molecule in the bacterial membrane and, for dalbavancin and oritavancin, binds plasma proteins so tightly that the drug stays in the body for days to weeks. 234
They are given by intravenous infusion only. Dalbavancin and oritavancin are designed so that one or two infusions 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 and stop the wall from being cross-linked, so the bacterium bursts under its own pressure. Oritavancin and telavancin add a second action: the lipid tail inserts into the bacterial membrane and disrupts it, which is why they kill bacteria faster than vancomycin in the laboratory and retain activity against some vancomycin-resistant strains. The drugs act only on Gram-positive bacteria such as Staphylococcus aureus (including MRSA) and streptococci. 234
What human research shows
Boucher and colleagues reported DISCOVER 1 and 2, two identically designed double-blind, double-dummy randomized trials run at 140 sites in 2011 and 2012. Patients with acute bacterial skin infections received dalbavancin on days 1 and 8 or intravenous vancomycin for at least three days with an option to switch to oral linezolid, for 10 to 14 days. Early clinical response (fever resolved and lesion stopped spreading at 48 to 72 hours) occurred in 525 of 659 dalbavancin patients (79.7%) and 521 of 653 comparator patients (79.8%), meeting non-inferiority. Fewer adverse events were reported with dalbavancin. 1
The oritavancin and telavancin labels summarize their own non-inferiority programmes against vancomycin (SOLO I and II for oritavancin; ATLAS for telavancin in skin infection and ATTAIN for pneumonia). Telavancin's pneumonia approval was restricted to patients for whom alternatives are not suitable because mortality was 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; nausea, headache and diarrhoea are the common complaints, and infusion reactions resembling vancomycin's red-man syndrome can occur if the infusion is too fast. Oritavancin interferes with coagulation tests for days and is contraindicated with intravenous heparin for 120 hours after a dose. 23
Telavancin carries boxed warnings: higher mortality than vancomycin in pneumonia patients with moderate to severe pre-existing kidney impairment, new or worsening kidney toxicity, and fetal harm in animal studies, so pregnancy status must be checked before use in women who could be pregnant. It also causes taste disturbance and foamy urine. The long persistence of dalbavancin and oritavancin means an adverse reaction cannot be stopped by withdrawing the drug. 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) since 2009, dalbavancin (Dalvance) and oritavancin (Orbactiv) since 2014, with a second oritavancin product (Kimyrsa) in 2021. All are approved for skin and skin-structure infections (acute bacterial for dalbavancin and oritavancin, complicated for telavancin); telavancin also 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 tissue levels 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 pathogen for all three, along with methicillin-susceptible strains and streptococci. They do not act on Gram-negative bacteria. 234
What is the biggest safety concern?
For telavancin, kidney toxicity and the excess deaths seen in pneumonia patients who already had kidney impairment, both boxed warnings. For oritavancin, interference with blood-clotting tests and with heparin for five days. For all of them, an adverse reaction to a long-acting drug cannot be reversed by stopping it. 432