Oritavancin

Summary

Oritavancin is a semi‑synthetic lipoglycopeptide used intravenously for acute bacterial skin and skin‑structure infections (ABSSSI) caused by susceptible Gram‑positive organisms, including MRSA.

Mechanism of Action

Binds to the D-Ala-D-Ala terminus of peptidoglycan precursors, inhibiting cell‑wall transglycosylation and transpeptidation; also disrupts bacterial membrane integrity.

Routes of Administration

Goals & Uses

• Single-dose outpatient antibiotic therapyHealthcare UtilizationHigh
• Treatment of ABSSSIInfectious DiseaseHigh
• Treatment of MRSA infectionsAntimicrobialHigh
• Treatment of VRE infectionsAntibacterial TherapyLow
• Coverage of MRSA and VREAntimicrobial SpectrumHigh
• Treatment of ABSSSI due to gram-positive pathogensAntibacterial TherapyHigh

Contraindications

• Severe hepatic impairment (Child‑Pugh C)Liver DiseaseModerate
• Unfractionated heparin sodium use within 120 hoursDrug InteractionHigh
• Hypersensitivity to oritavancin or other glycopeptidesAllergyHigh
• Known hypersensitivity to oritavancin or glycopeptidesAllergyHigh

Adverse Effects

• HepatotoxicityHepaticUncommonLiver injury or dysfunction
• AnaphylaxisImmunologicRareSevere life-threatening allergic reaction
• OsteomyelitisMusculoskeletalUncommon
• Infusion-related reactions (flushing, pruritus, urticaria)Infusion ReactionCommon
• HeadacheNeurologicCommonPain in the head or upper neck
• Infusion‑related reactions (flushing, pruritus, rash)LocalCommon
• Nausea/vomitingGastrointestinalCommon
• Clostridium difficile-associated diarrheaGastrointestinalRare
• NauseaGastrointestinalCommonFeeling of sickness or urge to vomit
• Elevated liver enzymesHepaticUncommonIncrease in AST/ALT or other hepatic markers

Drug Interactions

• Other anticoagulants (e.g., direct oral anticoagulants)Low
• CYP2C9/CYP2C19 substrates (e.g., phenytoin, warfarin)Low
• WarfarinModerate
• Unfractionated HeparinHigh

Population Constraints

• PregnancyReproductive SafetyRelative
• Hepatic impairment (severe)HepaticRelative
• Renal impairmentOrgan ImpairmentRelative
• Pediatric patients (<18 years)AgeRelative
• Pediatric patients (<18 y)AgeRelative
• Pregnancy and lactationReproductiveRelative

Regulatory Status

• European UnionApprovedApproved: Acute bacterial skin and skin‑structure infectionsMarketing authorization granted 2015; same dosing schedule.
• United StatesApprovedApproved: Acute bacterial skin and skin‑structure infectionsApproved 2014; single‑dose IV regimen.
• United KingdomApprovedApproved: Acute bacterial skin and skin structure infections (ABSSSI) in adultsApproved by MHRA; indications consistent with EU approval.

FDA‑approved in 2014 (Orbactiv) for ABSSSI; later approved in the EU for the same indication. Not recommended for routine use in pregnancy or pediatric patients without specific data.

Evidence & Sources

No sources recorded yet.

Frequently Asked Questions