What it is
Dalbavancin is an antibiotic whose core is seven amino acids, with sugars and a fatty tail attached. That makes it a lipoglycopeptide: "glyco" for the sugars, "lipo" for the fat, "peptide" for the core. A 2010 review in Drugs by Zhanel and colleagues describes the heptapeptide core as "common to all glycopeptides" — the class that includes vancomycin (PMID 20426497).
It is not one molecule. The Dalvance label describes a mixture of five closely related forms — A0, A1, B0, B1 and B2 — that share the core and differ only in the fatty side chain or one extra methyl group. B0 is the main component, molecular weight 1,816.7.
It starts in a microbe. The label says it is synthesised from a fermentation product of a Nonomuraea species; Sosio and Donadio named that product as the natural glycopeptide A40926, which dalbavancin is made from by chemical modification (PMID 16761167).
How it works
Bacteria build their cell wall as a sugar mesh stitched together by short peptides — the structure explained in the peptidoglycan entry. The label's mechanism is precise: dalbavancin binds the D-alanyl-D-alanine terminus of the stem pentapeptide in newly made peptidoglycan, preventing cross-linking. In the lab it is bactericidal against Staphylococcus aureus and Streptococcus pyogenes at concentrations similar to those sustained in treated patients.
The fatty tail is what changes the drug's behaviour. Zhanel's review says the lipophilic side chains of the lipoglycopeptides prolong their half-life and help anchor them to the bacterial membrane.
The half-life, in days
| Measure (Dalvance label) | Value |
|---|---|
| Terminal half-life, healthy subjects (n = 12) | 346 hours — about 14.4 days (our division by 24) |
| Effective half-life, population analysis of patients | About 8.5 days (204 hours) |
| Plasma protein binding | About 93%, mainly to albumin |
That is why a full course for a skin infection is so short.
What the trials show
All three trials are on the label.
| Trial (label) | Design | Early clinical response at 48–72 h |
|---|---|---|
| Trial 1 | Two-dose dalbavancin vs vancomycin (optional switch to oral linezolid), double-blind | 240/288 (83.3%) vs 233/285 (81.8%); difference 1.5 (95% CI −4.6 to 7.9) |
| Trial 2 | Same design | 285/371 (76.8%) vs 288/368 (78.3%); difference −1.5 (95% CI −7.4 to 4.6) |
| Trial 3 | Single 1,500 mg dose vs two doses, double-blind, 698 patients | 284/349 (81.4%) vs 294/349 (84.2%); difference −2.9 (95% CI −8.5 to 2.8) |
Two limits the label states. These are non-inferiority designs: they show dalbavancin performed in the same range as the comparator, not that it was better. And for the later follow-up visit the label notes there are insufficient historical data to use those success rates to establish non-inferiority. Across the first two trials, 59% of patients were enrolled in Eastern Europe and 36% in North America.
Doses on the label
Reported for reference; dosing is decided by the treating team.
| Group (label) | Dose |
|---|---|
| Adults, kidney clearance 30 mL/min or more (or on regular haemodialysis) | 1,500 mg once, or 1,000 mg then 500 mg one week later |
| Adults, clearance below 30 mL/min, not on dialysis | 1,125 mg once, or 750 mg then 375 mg |
| Children, birth to under 6 years | 22.5 mg/kg once (maximum 1,500 mg) |
| Children, 6 to under 18 years | 18 mg/kg once (maximum 1,500 mg) |
Each dose is an intravenous infusion over 30 minutes; the label warns that faster infusion can cause flushing of the upper body, urticaria, itching, rash or back pain.
Safety
Across 2,473 adults in the label's safety pool, serious adverse reactions occurred in 121 (4.9%); in the comparator-controlled trials the rate was 6.1% on dalbavancin and 6.5% on comparators. The most common reactions (over 4%) were nausea, headache and diarrhoea.
The liver signal is specific: among patients with normal baseline ALT, 17 (0.8%) on dalbavancin had a rise above three times the upper limit of normal — five above ten times — against 2 (0.2%) on comparators. The label reports the rises as reversible in everyone followed up. It also warns about cross-sensitivity in people allergic to other glycopeptides, and about C. difficile diarrhoea, as for nearly all antibiotics.
On resistance, the label says resistant isolates have not been seen in serial-passage or animal experiments. The Zhanel review adds a limit from lab testing: enterococci with the VanA phenotype — resistant to both vancomycin and teicoplanin — are resistant to dalbavancin as well.
Where it stands
- Approved in the US on 2014-05-23 (Dalvance, NDA 021883, now AbbVie).
- Generics: five applications approved between 2025-10-23 and 2026-06-04 (Teva, Fresenius Kabi, Kindos, Long Grove, BE Pharmaceuticals), all listed as prescription products (Drugs@FDA, 2026-10-06).
- Research record: PubMed indexes 913 records, 15 tagged as randomised trials (2026-10-06).
Related reading
The structure dalbavancin attacks is in the peptidoglycan entry. An antifungal built on a different peptide ring, aimed at a different wall, is micafungin, and the body's own antimicrobial peptide is described in the LL-37 entry.