Successful treatment of methicillin-sensitive Staphylococcus aureus tricuspid-valve endocarditis with dalbavancin as an outpatient in a person who injects drugs: A case report

There is a paucity of literature on the use of dalbavancin, a long-acting lipoglycopeptide, in infective endocarditis. Existing case reports have investigated dalbavancin in endocarditis as a sequential treatment after clearance of bacteria from the bloodstream with conventional therapy. A 27-year-old female who injects drugs presented with fever and pleuritic chest pain and was found to have methicillin-sensitive Staphylococcus aureus tricuspid-valve endocarditis with septic pulmonary emboli. Given non-adherence with conventional therapy, she was successfully treated off-label with once-weekly dalbavancin infusions in an outpatient setting. We summarize the patient's clinical course and review published reports of endocarditis treated with dalbavancin in the peer-reviewed literature. Our case supports further investigation of outpatient dalbavancin infusions as a reasonable therapeutic alternative to standard treatment with daily intravenous therapy for serious staphylococcal infections among patients who have difficulty engaging with conventional therapy.