JAMA

Two-dose dalbavancin not superior to standard care, but may simplify management of S. aureus bacteremia

August 14, 2025

Study details: DOTS, an open-label, assessor-masked randomized trial (NCT04775953) enrolled 200 hospitalized adults with complicated S. aureus bacteremia across 23 North American centers. Eligible patients had cleared bacteremia after 72 hours to 10 days of initial antibiotics. Participants were randomized to receive either two doses of IV dalbavancin (1500 mg on days 1 and 8) or 4 to 8 weeks of standard IV therapy (cefazolin/penicillin for MSSA; vancomycin/daptomycin for MRSA). Primary endpoint: desirability of outcome ranking (DOOR) at day 70.

Results: Dalbavancin didn’t demonstrate superiority: the probability of a more desirable DOOR outcome was 48% (95% confidence interval [CI], 39.8%–55.7%). Clinical efficacy at day 70 was similar between groups (73% dalbavancin vs. 72% standard therapy), meeting noninferiority criteria. Serious adverse events occurred in 40% of dalbavancin recipients vs. 34% in the standard group; treatment-related events were rare.

Clinical impact: Although not superior, dalbavancin’s comparable efficacy and simplified dosing may support its use in select patients, especially those for whom long-term IV access is impractical or risky. These findings may inform outpatient management strategies for complicated S. aureus bacteremia.

Source:

Turner NA, et al; Antibacterial Resistance Leadership Group. (2025, August 13). JAMA. Dalbavancin for Treatment of Staphylococcus aureus Bacteremia: The DOTS Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/40802264/