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PACU Literature Review #13. Oritavancin versus Oral Antibiotics for Treatment of Skin and Skin Structure Infections in the ED

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Sacdal JPA, Cheon E, Stilwell AM, Acquisto NM, Treu CN. Oritavancin versus oral antibiotics for treatment of skin and skin structure infections in the emergency department. Am J Emerg Med. 2022 Jul 8:S0735-6757(22)00448-X. doi: 10.1016/j.ajem.2022.07.013. Epub ahead of print.
PMID: 35835659.


  • To compare adult ED patients gram-positive SSTI treated with oritavancin to those who required IV antibiotics/hospitalization but left against medical advice (AMA) and therefore received oral antibiotics.


  • Before/After observational study


  • Oritavancin, n=51
  • Oral Antibiotics, n=31


  • Outcomes
    • ED revisit
      • Oritavancin 16% vs. 36% oral antibiotics (p = 0.06)
    • Hospitalization for worsening infection
      • Oritavancin 12% vs. 26% oral antibiotics (p = 0.13)
    • Secondary Outcomes
      • There was no difference in additional antibiotics within 30 days (both groups 35%).
      • Mean ED LOS was longer for oritavancin patients, 529 ± 126 vs. 448 ± 231 min (p = 0.04).


  • Single-dose oritavancinwas associated with clinically, but not statistically, significant reductions in 30-day ED visits and hospitalizations for worsening infection compared to patients treated with OAB because of refusing hospitalization/leaving AMA. Additional studies in high acuity settings with larger sample sizes are needed to identify the optimal population for oritavancin.


  • Corey GR, Kabler H, Mehra P, et al. Single-dose oritavancin in the treatment of acute bacterial skin infections. N Engl J Med. 2014;370(23):2180–90..
  • Dretske D, Schulz L, Werner E, et al. Effectiveness of oritavancin for management of skin and soft tissue infections in the emergency department: a case series. Am J Emerg Med. 2021;43:77–80.
  • Whittaker C, Lodise TP, Nhan E, et al. Expediting discharge in hospitalized, adult patients with skin and soft tissue infections who received empiric vancomycin therapy with Oritavancin: description of findings from an institutional pathway. Drugs Real World Outcomes. 2020;7(Suppl. 1):30–5.