Background: Oritavancin is a long-acting semisynthetic lipoglycopeptide with potent activity against a broad range of Gram-positive pathogens. Its multimodal mechanism of action and prolonged terminal half-life allow for extended dosing intervals, making it an off-label option for invasive infections requiring long-term antimicrobial exposure. However, evidence supporting its use in infective endocarditis and cardiac device-related infections remain limited. Methods: We performed a retrospective multicentre observational study including adult patients treated with multidose oritavancin for infective endocarditis and cardiac device-related infections between 2020 and 2025. Oritavancin was administered as consolidation or as long-term suppressive therapy. Demographic, clinical, microbiological, pharmacological, and outcome data were collected. Therapeutic drug monitoring was performed, and pre-dose plasma concentrations were analysed. Clinical outcomes included clinical cure, microbiological failure, adverse events, and 30- and 90-day all-cause mortality. Results: Nine patients were included. Oritavancin was mainly administered at 1200 mg per dose, with a median dosing interval of 10 days. Clinical success was achieved in 6/9 patients (66.7%). One patient discontinued therapy due to infusion-related adverse events, and two experienced microbiological failure, both in left ventricular assist device-related infections. No 30- or 90-day mortality was observed. TDM, when performed, demonstrated persistent pre-dose plasma concentrations over several weeks, with marked interindividual variability across patients and intra-individual temporal changes over time, including drug accumulation in some cases. Conclusion: Multidose oritavancin appears to be a promising consolidation or suppressive strategy in selected patients with complex Gram-positive endovascular infections. Prospective studies are needed to define optimal dosing regimens and the role of TDM in this setting.
Oritavancin as consolidation or suppressive therapy in infective endocarditis and device-related infections: real-world experience with therapeutic drug monitoring
Gaibani, Paolo;
2026-01-01
Abstract
Background: Oritavancin is a long-acting semisynthetic lipoglycopeptide with potent activity against a broad range of Gram-positive pathogens. Its multimodal mechanism of action and prolonged terminal half-life allow for extended dosing intervals, making it an off-label option for invasive infections requiring long-term antimicrobial exposure. However, evidence supporting its use in infective endocarditis and cardiac device-related infections remain limited. Methods: We performed a retrospective multicentre observational study including adult patients treated with multidose oritavancin for infective endocarditis and cardiac device-related infections between 2020 and 2025. Oritavancin was administered as consolidation or as long-term suppressive therapy. Demographic, clinical, microbiological, pharmacological, and outcome data were collected. Therapeutic drug monitoring was performed, and pre-dose plasma concentrations were analysed. Clinical outcomes included clinical cure, microbiological failure, adverse events, and 30- and 90-day all-cause mortality. Results: Nine patients were included. Oritavancin was mainly administered at 1200 mg per dose, with a median dosing interval of 10 days. Clinical success was achieved in 6/9 patients (66.7%). One patient discontinued therapy due to infusion-related adverse events, and two experienced microbiological failure, both in left ventricular assist device-related infections. No 30- or 90-day mortality was observed. TDM, when performed, demonstrated persistent pre-dose plasma concentrations over several weeks, with marked interindividual variability across patients and intra-individual temporal changes over time, including drug accumulation in some cases. Conclusion: Multidose oritavancin appears to be a promising consolidation or suppressive strategy in selected patients with complex Gram-positive endovascular infections. Prospective studies are needed to define optimal dosing regimens and the role of TDM in this setting.
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