Guidelines
Dalbavancin: Criteria for ED Use

Dalbavancin: Criteria for ED Use

Inclusions

  1. Adult
  2. Cellulitis, abscess, or wound associated with ≥75 cm of erythema (~ size of your palm)
  3. Due to suspected/confirmed Gram positive pathogen
  4. ≥ 2 signs of local infection
  5. Lactate < 2 IF signs of systemic infection are present
  6. Patient requires IV antibiotics for this infection

Note: sign of systemic infection (i.e. WBC ≥ 12, fever, tachycardia) are not an exclusion to use

Exclusions

  1. SSTI not requiring hospitalization and/or oral therapy is appropriate
  2. Allergy to Vanco, telavancin, dalbavancin, or oritavancin (not infusion related)
  3. Infection type/location is: perirectal/perineal, decubitus ulcer, animal/human bite, surgical site infection, or involves joint, hand, tendons, head/ deep neck space
  4. Comorbidities: Severe hepatic disease, severely immunocompromised
  5. Pregnant or breastfeeding
  6. Concern for gram negative, anaerobic, or vancomycin (or dalbavancin)-resistant pathogens
  7. Concern for necrotizing fasciitis, bacteremia, IE, osteomyelitis, or catheter-related infection
  8. Further intervention (surgical or otherwise) anticipated after ED care
  9. Serious infection requiring broad-spectrum antibiotics or more intensive care
  10. Another unstable condition or comorbidity that requires hospitalization
  11. No other factors that warrant admission in the judgement of the provider

Provider Steps

Prior to Administration

  1. Draw pre-antibiotic blood cultures x 2 and lactate if indicated
  2. Obtain wound cultures if bedside I&D performed
  3. Outline margins of erythema and document the size of the infection with photo in Epic
  4. Enter .DISCHARGEABX smart phrase in encounter note and complete

Prior to ED Discharge

  1. Patient/provider sign paperwork for dose replacement if patient is uninsured
  2. Provide follow-up instructions