Case Series: Use of Dalbavancin for Invasive Gram-Positive Infection in Children

OBJECTIVE Dalbavancin, a lipoglycopeptide antibiotic active against Gram-positive bacteria with a prolonged in vivo half-life, was recently approved by the Food and Drug Administration for use in pediatric skin/ soft tissue infection. Although use in adult skin/soft tissue infection and off-label use in adult osteoarticular and bloodstream infection are well documented, pediatric data are limited to pharmacokinetic data, 1 clinical trial, and case reports/series. Here, we describe the clinical and microbiologic details of cases in which dalbavancin was used at 2 pediatric hospitals. METHODS Chart review of all patients receiving dalbavancin for any indication in 2 pediatric hospitals between August 2020 and July 2025. RESULTS Dalbavancin was used in 20 patients (age range 2 weeks to 18 years) in the time period. Fifteen cases had infection with either methicillin-susceptible or-resistant Staphylococcus aureus, 16 had bacteremia, 2 had endocarditis, and 11 cases had isolates available for dalbavancin susceptibility testing; all proved susceptible. Reasons for dalbavancin use included need for intravenous therapy with relative contraindications for alternative oral antibiotics or outpatient parenteral antibiotic therapy, difficulty of intravenous access, and medication nonadherence. Most cases had an uncomplicated recovery. None had microbiologic failure. CONCLUSIONS With the limitations of this series and prior published data, dalbavancin may be a safe and efficacious antibiotic for use in certain invasive Gram-positive infections in children. It is a reasonable alternative when faced with relative contraindications to inpatient or outpatient parenteral therapy, especially when bactericidal therapy is needed or preferred. Formal pediatric trials against the standard of care, especially beyond skin/soft tissue infection, are encouraged.