oritavancin
Sources réglementaires consultées
Indications approuvées
- Infections bactériennes aiguës de la peau et des structures cutanées dues à des germes à Gram positif sensibles.
Contre-indications
Absolues
- Hypersensibilité à l’oritavancine ; utilisation d’héparine non fractionnée IV pendant les 120 heures suivantes.
Mises en garde cliniques
- Mise en garde majeure · Il interfère avec le TCA jusqu’à 120 h, le TP/INR jusqu’à 12 h et l’ACT jusqu’à 24 h ; utiliser des tests non affectés. — CIMA/AEMPS, ficha técnica 115989001
- Mise en garde majeure · Il peut provoquer une hypersensibilité et une réaction de perfusion. Un signal d’ostéomyélite a été observé ; évaluer toute douleur osseuse persistante. — CIMA/AEMPS, ficha técnica 115989001
Interactions médicamenteuses
- ModéréeHéparine non fractionnée IV
Mécanisme: L’interférence prolongée avec le TCA empêche une surveillance fiable.
Recommandation: Ne pas administrer pendant 120 heures après l’oritavancine.
CIMA/AEMPS, ficha técnica 115989001
- SévèreWarfarine
Mécanisme: L’INR n’est pas fiable pendant les 12 premières heures et le risque hémorragique peut augmenter.
Recommandation: Surveiller cliniquement les saignements et utiliser un test alternatif pendant l’interférence.
CIMA/AEMPS, ficha técnica 115989001
- ModéréeSubstrats du CYP2C9, CYP2C19, CYP3A4 ou CYP2D6 à marge thérapeutique étroite
Mécanisme: L’oritavancine inhibe faiblement les CYP2C9/2C19 et induit faiblement les CYP3A4/2D6.
Recommandation: Surveiller l’efficacité, les concentrations ou la toxicité du substrat et adapter si nécessaire.
CIMA/AEMPS, ficha técnica 115989001
Effets indésirables
Communs (≥1%)
Nausées, hypersensibilité, réaction au site de perfusion et céphalées
Rares mais graves
Anaphylaxie, réaction de perfusion sévère et ostéomyélite
Grossesse et allaitement
Éviter pendant la grossesse sauf si le bénéfice l’emporte sur le risque. Décider d’arrêter soit l’allaitement, soit le traitement.
Bibliographie récente (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).