New Study Backs Long-Acting Lipoglycopeptides as Step-Down Option for Serious Bacterial Infections
USA: A large-scale US-based study has found that long-acting lipoglycopeptides (laLGPs), including dalbavancin and oritavancin, are as effective as standard-of-care (SOC) antibiotics in the step-down treatment of serious gram-positive bacterial infections. The findings, published in JAMA Network Open, offer new possibilities for treating individuals who may face barriers to prolonged intravenous therapy.
Conducted by Dr. David Goodman-Meza and his team from the Division of Infectious Diseases at the David Geffen School of Medicine at UCLA in Los Angeles, USA, the study assessed real-world data from 42,067 adults hospitalized with serious bacterial infections such as bacteremia, endocarditis, osteomyelitis, and septic arthritis. The analysis spanned data collected between October 2015 and October 2022 using the Cerner Real World Data platform.
LaLGPs, a class of antibiotics with extended dosing intervals, have gained attention as they allow for less frequent administration, which is especially beneficial for patients unable to access daily intravenous antibiotics, such as persons who use drugs (PWUD). The study aimed to evaluate whether these agents could serve as viable alternatives to conventional regimens.
The researchers used a target trial emulation framework to compare outcomes between patients receiving laLGPs and those receiving standard antibiotics. The primary outcome was a composite measure of hospital readmission, emergency department (ED) visits, and inpatient death or hospice discharge within 90 days following hospital discharge.
Among the cohort, the median age was 61 years, with approximately 59% male participants. Notably, about 12% of patients were identified as PWUD. Of the entire sample, 825 individuals (2%) received laLGPs.
The key findings include the following:
- There was no significant difference in the primary outcome between the laLGP and standard-of-care (SOC) antibiotic groups.
- Among persons who use drugs (PWUD), the hazard ratio (HR) was 1.01.
- In the non-PWUD population, the HR was 0.93.
- These results indicate that laLGPs are neither superior nor inferior to SOC antibiotics.
- The findings support laLGPs use as an effective step-down treatment option for serious infections.
- Their comparable effectiveness makes laLGPs a suitable alternative in cases where IV access is difficult.
- LaLGPs may also benefit patients with limited ability to adhere to outpatient treatment regimens.
- This treatment option could significantly influence care strategies for underserved or high-risk populations.
The study emphasized the potential of laLGPs to simplify treatment regimens without compromising clinical outcomes. As antibiotic stewardship and individualized patient care become increasingly important, incorporating such alternatives could enhance convenience and healthcare efficiency.
"The research highlights that long-acting antibiotics may provide a practical and equally effective alternative to standard antibiotics for managing serious gram-positive infections, particularly in populations with limited access to conventional IV therapies," the researchers concluded.
Reference:
Goodman-Meza D, Weiss RE, Poimboeuf ML, et al. Comparative Effectiveness of Long-Acting Lipoglycopeptides vs Standard-of-Care Antibiotics in Serious Bacterial Infections. JAMA Netw Open. 2025;8(5):e2511641. doi:10.1001/jamanetworkopen.2025.11641
