Oritavancin (Orbactiv): Another Long-Acting Antibiotic for MRSA

Purulent skin and soft-tissue infections are now mostly caused by methicillin-resistant staph aureus (MRSA) that are resistant not only to methicillin, but also to all other penicillins and all but one cephalosporin. When these infections appear to be serious, they are generally treated in a hospital with vancomycin IV twice a day for 7-14 days. Vanco has a long track record in treating these infections; clinical failures are infrequent and resistant strains of MRSA are still rare. And the drug is inexpensive, but the hospital, of course, is not.

The next issue of The Medical Letter (January 5, 2015) includes an article on oritavancin (Orbactiv), a new lipoglycopeptide antibiotic that that only needs to be given once. Not once a day, but once, period. It is the second long-acting lipoglycopeptide antibiotic to be marketed for this indication; dalbavancin (Dalvance), which is given in 2 doses a week apart, was the first. Both of these drugs cost much more than vancomycin. That single dose of oritavancin costs about $3000 for the drug alone, but if it permits outpatient treatment of an infection that previously required hospitalization, that would be a bargain.

Having therapeutic blood levels of a drug last for a week is wonderful until side effects occur, and oritavancin, like the other glycopeptides, has some toxicity. Still, keeping patients out of the hospital avoids some other risks, including those to patients’ solvency if their insurance is inadequate. For more information that can help prescribers evaluate the place of this new agent in the treatment of this common infection, watch for the next issue of The Medical Letter.

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  1. This drug sounds like it could be a bed-saver in a hospital, but most places have no architecture to administer it without admitting the patient to a bed.
    Oritavancin requires a 3-hour infusion, a liter of fluid (that’s 333ml/hr), and administrative time, not to mention IV access and de-access.
    In my role as clinical pharmacy coordinator at a regional medical center in Southern Oregon I’ve seen a couple of sales reps about this drug.
    My conclusion is that simply ADMINISTERNG this drug poses a big challenge for hospitals. Finding a space to tie up for the 4 – 6 hours or so that it’ll take is almost impossible at the present time.
    Emergency Rooms won’t want to tie up a room for that length of time, outpatient infusion centers have their own process problems with “drive-by patients” (i.e. see them once then send them on their way), and no one wants to admit a patient to a medical floor with the expectation that they’ll leave later in the day.
    FYI: for 340B DSH hospitals: the 340B price for the drug is a discount of 25%.
    My conclusion: in the absence of capital improvement projects that would create space, the best place (and value) for this drug is in places that can keep patients from ever hitting the door at the ER. Walk-in urgent care centers that may be more flexible in space and time. No walk-in patient will be able to afford it, so access to the drug will also pose a big challenge for most patients.

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