Hospital Pharmacy - July/August 2018 - 272

746415
research-article2017

HPXXXX10.1177/0018578717746415Hospital PharmacyCo et al

Article
Hospital Pharmacy
2018, Vol. 53(4) 272-276
© The Author(s) 2017
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https://doi.org/10.1177/0018578717746415
DOI: 10.1177/0018578717746415
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Evaluation of Oritavancin Use
at a Community Hospital
Daniel Co1, Leslie Roebuck1, and Jason VanLandingham1

Abstract
Background: Oritavancin is a lipoglycopeptide antibiotic indicated for the treatment of acute bacterial skin and soft tissue
infections. The prolonged half-life of this agent allows for a course of therapy to be completed with a single dose. Oritavancin
was added to our formulary as an option for treatment of acute bacterial skin and soft tissue infection to reduce admission
and length of stay. Objective: The purpose of this study was to determine whether oritavancin is used appropriately at
our hospital and to evaluate the impact to the institution. Methods: A retrospective and concurrent chart review was
performed on all patients who had received oritavancin within our health system between June 2015 and December 2016.
The primary endpoint was to determine the appropriateness of oritavancin use. Secondary endpoints include documenting
readmission rates for patients prescribed oritavancin and assessing potential financial benefits to the institution. Results:
In the 67 patients identified, 51 (76%) patients received oritavancin for an appropriate indication. Orders from infectious
disease physicians constituted 81% of inappropriate cases of oritavancin use. No patients who received oritavancin required
readmission within 14 days of therapy. The estimated potential financial benefit to our institution when using oritavancin to
prevent hospital admissions was $653,451. Conclusions: The majority of oritavancin use at our institution is appropriate
according to indication. Oritavancin offers an outpatient option for the treatment of acute bacterial skin and soft tissue
infections with the potential to decrease hospital cost by reducing admissions and length of stay.
Keywords
anti-infectives, cost effectiveness, drug/medical use evaluation, infectious diseases

Background and Objective
The treatment of acute bacterial skin and soft tissue infections (ABSSTIs) remains a significant economic burden to
patients and hospitals across the United States. ABSSTIs
contribute to the rapidly expanding volume of emergency
department (ED) visits and are attributed to roughly 10% of
all US hospital admissions.1 The Infectious Diseases Society
of America (IDSA) recommends that these infections be
treated with 5 to 14 days of antibiotics,2 often requiring a
multiple day admission with the associated costs of room,
medications, laboratory tests, intravenous lines, and so on.
In August 2014, the US Food and Drug Administration
(FDA) approved the lipoglycopeptide antibiotic oritavancin (Orbactiv; The Medicines Company, Parsippany,
New Jersey) for the treatment of adult patients with
ABSSTIs. Oritavancin is indicated for the treatment of
infections caused by certain gram-positive organisms,3
including Staphylococcus aureus and methicillin-resistant
Staphylococcus aureus (MRSA). A course of therapy for
oritavancin consists of one 1200-mg intravenous dose,
making it the first single-dose treatment option for
ABSSTIs approved by the FDA. Dosing for oritavancin

does not require adjustment for patient weight, age, renal
impairment, or hepatic impairment.3
Because a course of therapy can be completed with a
1-time infusion, it has been postulated that oritavancin may
be used in a cost avoidance strategy to shorten length of stay
or even eliminate the need for a hospital admission to treat an
ABSSTI. Data to support the use of oritavancin as an alternative to inpatient treatment are provided by the SOLO I and
SOLO II trials, two phase III, randomized, multicenter, international, double-blind studies which compared the efficacy
and safety of single-dose oritavancin with 7 to 10 days of
intravenous vancomycin in adults with ABSSTIs. For the
efficacy assessments of cessation of spread/reduction in size
of baseline lesion, absence of fever, need for rescue antibiotics, and investigator-assessed clinical cure 7 to 14 days after
the end of treatment, the results of these trials showed no
1

Northeast Georgia Health System, Inc, Gainesville, USA

Corresponding Author:
Daniel Co, Department of Pharmacy, Northeast Georgia Health System,
Inc, 743 Spring Street, Gainesville, GA 30503, USA.
Email: danielco@ernesthealth.com
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