oritavancin
Fuentes regulatorias consultadas
Indicaciones aprobadas
- Infecciones bacterianas agudas de piel y estructuras cutáneas por grampositivos sensibles.
Contraindicaciones
Absolutas
- Hipersensibilidad a oritavancina; uso de heparina no fraccionada IV durante las 120 horas posteriores.
Advertencias clínicas
- Advertencia mayor · Interfiere con aPTT hasta 120 h, PT/INR hasta 12 h y ACT hasta 24 h; usa pruebas no afectadas. — CIMA/AEMPS, ficha técnica 115989001
- Advertencia mayor · Puede causar hipersensibilidad y reacción de perfusión. Se observó una señal de osteomielitis; evalúa dolor óseo persistente. — CIMA/AEMPS, ficha técnica 115989001
Interacciones medicamentosas
- ModeradaHeparina no fraccionada IV
Mecanismo: La interferencia prolongada con aPTT impide monitorización fiable.
Recomendación: No administrar durante 120 horas tras oritavancina.
CIMA/AEMPS, ficha técnica 115989001
- SeveraWarfarina
Mecanismo: El INR no es fiable durante las primeras 12 horas y puede aumentar el riesgo de sangrado.
Recomendación: Vigila clínicamente el sangrado y usa una prueba alternativa durante la interferencia.
CIMA/AEMPS, ficha técnica 115989001
- ModeradaSustratos de margen terapéutico estrecho de CYP2C9, CYP2C19, CYP3A4 o CYP2D6
Mecanismo: Oritavancina inhibe débilmente CYP2C9/2C19 e induce débilmente CYP3A4/2D6.
Recomendación: Vigila eficacia, concentraciones o toxicidad del sustrato y ajusta si es necesario.
CIMA/AEMPS, ficha técnica 115989001
Eventos adversos
Comunes (≥1%)
Náuseas, hipersensibilidad, reacción en el lugar de perfusión y cefalea
Raros pero graves
Anafilaxia, reacción de perfusión grave y osteomielitis
Embarazo y lactancia
Evita durante el embarazo salvo que el beneficio supere el riesgo. Decide entre suspender lactancia o tratamiento.
Bibliografía reciente (PubMed)
Today, Enterococcus faecalis is one of the main causes of infective endocarditis in the world, generally affecting an elderly and fragile population, with a high mortality rate. Enterococci are partially resistant to many commonly used antimicrobial agents such as penicillin and ampicillin, as well as high-level resistance to most cephalosporins and sometimes carbapenems, because of low-affinity penicillin-binding proteins, that lead to an unacceptable number of therapeutic failures with monotherapy. For many years, the synergistic combination of penicillins and aminoglycosides has been the cornerstone of treatment, but the emergence of strains with high resistance to aminoglycosides led to the search for new alternatives, like dual beta-lactam therapy. The development of multi-drug resistant strains of Enterococcus faecium is a matter of considerable concern due to its probable spread to E. faecalis and have necessitated the search of new guidelines with the combination of daptomycin, fosfomycin or tigecycline. Some of them have scarce clinical experience and others are still under investigation and will be analyzed in this review. In addition, the need for prolonged treatment (6-8 weeks) to avoid relapses has forced to the consideration of other viable options as outpatient parenteral strategies, long-acting administrations with the new lipoglycopeptides (dalbavancin or oritavancin), and sequential oral treatments, which will also be discussed.
Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are associated with high mortality rates. Optimal antibiotic dosage plays a crucial role in reducing MRSA burden; thus, the use of therapeutic drug monitoring (TDM) in the clinical practice, especially of new drugs such as ceftobiprole, ceftaroline, dalbavancin, and oritavancin, should be implemented. We aim to examine and summarize the available evidence about TDM of anti-MRSA molecules, with a focus on pneumonia, endocarditis and vascular infections, and bone and joint infections. We applied 'therapeutic drug monitoring' and 'Staphylococcus aureus' as search terms in PubMed, considering a time frame of 24 years (2001-2024). Articles in English language, non-duplicated, evaluating antibiotic therapeutic target, and role of TDM were included in the study. In this review, available data for therapeutic target and TDM were critically analysed and summarized and suggestions about the use of old and new anti-MRSA antibiotics were provided, focusing on optimal dosages, tissue penetration according to infection types, and toxicity. Limitations to the widespread use of TDM in clinical practice were discussed. The use of TDM may play an important role for the optimal management of patients with MRSA infections and may impact on patient outcomes by increasing efficacy and reducing the risk of adverse events. TDM may be implemented in clinical practice; however, several limitations such as the wide variability in the methodology and the need for skilled personnel need to be considered.
Oritavancin is emerging as a potential alternative to standard antibiotic regimens in the treatment of infective endocarditis caused by gram-positive bacteria, though evidence remains limited. We hereby report 7 cases of enterococcal endocarditis treated with oritavancin as consolidation therapy, resulting in 6 cures and 1 relapse.
This review discusses small molecule antibiotics approved for clinical use in the time frame 2010-2022. This time span saw the approval of four synthetic antibiotics (bedaquiline, pretomanid, delafloxacin, tedizolid), nine natural product derivatives (ceftaroline fosamil, cefiderocol, plazomicin, omadacycline, eravacycline, sarecycline, lefamulin, dalbavancin, oritavancin), and one natural product (fidaxomicin).