Expanding the Role of Dalbavancin in Children: A Case Series and Systematic Review.

BACKGROUND

Dalbavancin is a long-acting lipoglycopeptide antibiotic with activity against Gram-positive bacteria and is approved for the treatment of acute bacterial skin and skin structure infections. Its pharmacokinetic profile and tolerability make it an attractive option for pediatric infections requiring prolonged therapy, including off-label indications.

METHODS

A systematic review of the literature was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to evaluate the safety and effectiveness of dalbavancin in pediatric patients. Studies published between 2010 and 2025 were identified through searches of PubMed, Scopus and Web of Science. Clinical trials, pharmacokinetic studies, systematic reviews and case series were included. In addition, a retrospective observational study of pediatric patients treated with dalbavancin at a tertiary hospital between 2023 and 2025 was performed.

RESULTS

Ten studies met inclusion criteria, including clinical trials, pharmacokinetic analyses and pediatric case series. Seven patients (age range 5-17 years) were included in the institutional case series, most with significant comorbidities. Infections treated included osteoarticular infections, endocarditis or septic thrombophlebitis, and catheter- or device-related infections. Dalbavancin was primarily prescribed to shorten intravenous therapy, improve adherence and facilitate early discharge. All patients achieved clinical cure without relapse during follow-up, and no adverse events attributable to dalbavancin were observed.

CONCLUSIONS

Dalbavancin was well tolerated and was associated with favorable outcomes in selected pediatric patients with severe Gram-positive infections, supporting its potential role in facilitating early discharge and outpatient management. Prospective multicenter studies are needed to better define its safety and effectiveness beyond acute bacterial skin and skin structure infections.