{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T12:05:52Z","timestamp":1790856352338,"version":"4.1.0"},"reference-count":39,"publisher":"BioExcel","license":[{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"id":[{"id":"https:\/\/ror.org\/02h1wg091","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["DIC"],"abstract":"<jats:p>Background: Oritavancin is a long-acting lipoglycopeptide antibiotic approved for acute bacterial skin and skin structure infections (ABSSSI) with potential applicability across difficult-to-treat Gram-positive infections such as osteomyelitis, bacteraemia and endocarditis. This systematic review evaluates the efficacy, safety and clinical use of oritavancin across on-label and off-label indications.\n\nMethods: MEDLINE and CENTRAL were searched (2011\u2013 2024) for randomized trials, retrospective cohorts, case series and real-world evidence reporting clinical outcomes following oritavancin administration. Risk of bias was assessed using Critical Appraisal Skills Programme (CASP) tools for randomized clinical trials and cohort studies.\n\nResults: Twenty-five studies met inclusion criteria: 11 evaluating ABSSSI (n=2311) and 14 assessing off-label use (n=692), including for osteomyelitis, bacteraemia and endocarditis. Across ABSSSI randomized clinical trials, oritavancin demonstrated clinical cure rates of 79.6\u2013 83.3%, comparable to those of vancomycin. In retrospective studies, clinical success rates ranged from 85% to 88% in ABSSSI retrospective studies and from 70% to 100% in off-label studies. Adverse events were primarily mild to moderate.\n\nConclusions: Oritavancin is effective for ABSSSI and may be a promising treatment alternative for selected Gram-positive off-label indications requiring prolonged therapy. Standardized dosing strategies and prospective trials are needed to define optimal regimens for off-label indications.\n\nDownload the Plain Language Summary of this article: https:\/\/www.drugsincontext.com\/plain-language-summaries\/plain-language-summary-evaluating-oritavancin-for-gram-positive-infections-a-systematic-review-of-on-label-and-off-label-use<\/jats:p>","DOI":"10.7573\/dic.2025-9-4","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T09:08:36Z","timestamp":1773824916000},"page":"1","source":"Crossref","is-referenced-by-count":1,"title":["Evaluating oritavancin for Gram-positive infections: a systematic review of on-label and off-label use"],"prefix":"10.7573","author":[{"given":"Alex","family":"Soriano","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/021018s57","id-type":"ROR","asserted-by":"publisher"}],"name":"Universitat de Barcelona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Tascini","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05ht0mh31","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Udine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Falcone","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03ad39j10","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Pisa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Morata","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/021018s57","id-type":"ROR","asserted-by":"publisher"}],"name":"Universitat de Barcelona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Bongiovanni","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00sh19a92","id-type":"ROR","asserted-by":"publisher"}],"name":"Ente Ospedaliero Cantonale"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Pea","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01111rn36","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Bologna"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierluigi","family":"Viale","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01111rn36","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Bologna"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10047","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"1.\tLiu C, Bayer A, Cosgrove SE, et al. 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Open Forum Infect Dis. 2019;6(11):ofz479. https:\/\/doi. org\/10.1093\/ofid\/ofz479","DOI":"10.1093\/ofid\/ofz479"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"18.\tHelton B, MacWhinnie A, Minor SB, Lodise TP, Rafferty KD, Allison SL. Early directed oritavancin therapy in the emergency department may lead to hospital avoidance compared to standard treatment for acute bacterial skin and skin structure infections: a real-world retrospective analysis. Drugs Real World Outcomes. 2020;7(S1): 20\u201329. https:\/\/doi.org\/10.1007\/s40801-020-00201-y","DOI":"10.1007\/s40801-020-00201-y"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"19.\tWhittaker C, Lodise TP, Nhan E, Reilly J. 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. 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Antimicrob Agents Chemother. 2011;55(7):3476\u2013 3484. https:\/\/doi.org\/10.1128\/AAC.00029-11","DOI":"10.1128\/AAC.00029-11"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"22.\tCorey 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\u20132190. https:\/\/doi.org\/10.1056\/NEJMoa1310422","DOI":"10.1056\/NEJMoa1310422"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"23.\tCorey GR, Good S, Jiang H, et al. Single-dose oritavancin versus 7\u201310 days of vancomycin in the treatment of gram-positive acute bacterial skin and skin structure infections: the SOLO II noninferiority study. Clin Infect Dis. 2015;60(2):254\u2013262. https:\/\/doi.org\/10.1093\/cid\/ciu778","DOI":"10.1093\/cid\/ciu778"},{"key":"ref23","doi-asserted-by":"crossref","unstructured":"24.\tCorey GR, Arhin FF, Wikler MA, et al. Pooled analysis of single-dose oritavancin in the treatment of acute bacterial skin and skin-structure infections caused by Gram-positive pathogens, including a large patient subset with methicillin-resistant Staphylococcus aureus. Int J Antimicrob Agents. 2016;48(5):528\u2013534. https:\/\/doi.org\/10.1016\/j. ijantimicag.2016.07.019","DOI":"10.1016\/j.ijantimicag.2016.07.019"},{"key":"ref24","doi-asserted-by":"crossref","unstructured":"25.\tStewart CL, Turner MS, Frens JJ, Snider CB, Smith JR. Real-world experience with oritavancin therapy in invasive gram-positive infections. Infect Dis Ther. 2017;6(2):277\u2013289. https:\/\/doi.org\/10.1007\/s40121-017-0156-z","DOI":"10.1007\/s40121-017-0156-z"},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"26.\tSchulz LT, Dworkin E, Dela-Pena J, Rose WE. Multiple-dose oritavancin evaluation in a retrospective cohort of patients with complicated infections. Pharmacotherapy. 2018;38(1):152\u2013159. https:\/\/doi.org\/10.1002\/phar.2057","DOI":"10.1002\/phar.2057"},{"key":"ref26","doi-asserted-by":"crossref","unstructured":"27.\tBrownell LE, Adamsick ML, McCreary EK, et al. Clinical outcomes and economic impact of oritavancin for gram-positive infections: a single academic medical center health system experience. Drugs Real World Outcomes. 2020;7(S1):13\u201319. https:\/\/doi.org\/10.1007\/s40801-020-00192-w","DOI":"10.1007\/s40801-020-00192-w"},{"key":"ref27","doi-asserted-by":"crossref","unstructured":"28.\tVan Hise NW, Chundi V, Didwania V, et al. Treatment of acute osteomyelitis with once-weekly oritavancin: a two-year, multicenter, retrospective study. Drugs Real World Outcomes. 2020;7(S1):41\u201345. https:\/\/doi.org\/10.1007\/s40801- 020-00195-7","DOI":"10.1007\/s40801-020-00195-7"},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"29.\tVan Hise NW, Petrak RM, Shah K, Diaz M, Chundi V, Redell M. Oritavancin versus daptomycin for osteomyelitis treatment after surgical debridement. Infect Dis Ther. 2024;13(3):535\u2013547. https:\/\/doi.org\/10.1007\/s40121-024- 00925-2","DOI":"10.1007\/s40121-024-00925-2"},{"key":"ref29","doi-asserted-by":"crossref","unstructured":"30.\tMoenster RP, Wallace-Lacey A, Western H, et al. Oritavancin vs standard of care for treatment of nonendovascular Gram-positive bloodstream infections. Open Forum Infect Dis. 2023;10(11):ofad411. https:\/\/doi. org\/10.1093\/ofid\/ofad411","DOI":"10.1093\/ofid\/ofad411"},{"key":"ref30","doi-asserted-by":"crossref","unstructured":"31.\tBandaranayake TD, Radcliffe C, Cvercko M, Golden M, Hao RM. Experience with expanded use of oritavancin in a tertiary hospital: indications, tolerability and outcomes. JAC Antimicrob Resist. 2024;6(6):dlae174. https:\/\/doi. org\/10.1093\/jacamr\/dlae174","DOI":"10.1093\/jacamr\/dlae174"},{"key":"ref31","doi-asserted-by":"crossref","unstructured":"32.\tSteuber TD, Gipson H, Boyett B, Belk M, Thayer B, Edwards J. Head-to-head comparison of multi-dose oritavancin and dalbavancin for complicated infections: a propensity score-matched analysis. Int J Antimicrob Agents. 2024;63(6):107165. https:\/\/doi.org\/10.1016\/j.ijantimicag.2024.107165","DOI":"10.1016\/j.ijantimicag.2024.107165"},{"key":"ref32","doi-asserted-by":"crossref","unstructured":"33.\tTexidor WM, Miller MA, Molina KC, et al. Oritavancin as sequential therapy for Gram-positive bloodstream infections. BMC Infect Dis. 2024;24(1):127. https:\/\/doi.org\/10.1186\/s12879-023-08725-8","DOI":"10.1186\/s12879-023-08725-8"},{"key":"ref33","doi-asserted-by":"crossref","unstructured":"34.\tJohnson JA, Feeney ER, Kubiak DW, Corey GR. 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In Vivo. 2024;38(6):3106. https:\/\/doi.org\/10.21873\/ invivo.13795","DOI":"10.21873\/invivo.13795"},{"key":"ref36","doi-asserted-by":"crossref","unstructured":"37.\tMorrisette T, Miller MA, Montague BT, Barber GR, McQueen RB, Krsak M. On- and off-label utilization of dalbavancin and oritavancin for Gram-positive infections. J Antimicrob Chemother. 2019;74(8):2405\u20132416. https:\/\/doi. org\/10.1093\/jac\/dkz162","DOI":"10.1093\/jac\/dkz162"},{"key":"ref37","doi-asserted-by":"crossref","unstructured":"38.\tRedell M, Sierra-Hoffman M, Assi M, et al. The CHROME study, a real-world experience of single- and multiple-dose oritavancin for treatment of gram-positive infections. Open Forum Infect Dis. 2019;6(11):ofz479. https:\/\/doi. org\/10.1093\/ofid\/ofz479","DOI":"10.1093\/ofid\/ofz479"},{"key":"ref38","doi-asserted-by":"crossref","unstructured":"39.\tBandaranayake TD, Radcliffe C, Cvercko M, Golden M, Hao RM. Experience with expanded use of oritavancin in a tertiary hospital: indications, tolerability and outcomes. JAC Antimicrob Resist. 2024;6(6):dlae174. https:\/\/doi. org\/10.1093\/jacamr\/dlae174","DOI":"10.1093\/jacamr\/dlae174"}],"container-title":["Drugs in Context"],"original-title":[],"link":[{"URL":"https:\/\/www.drugsincontext.com\/wp-content\/uploads\/2026\/03\/dic.2025-9-4.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T11:21:16Z","timestamp":1790853676000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.drugsincontext.com\/evaluating-oritavancin-for-gram-positive-infections-a-systematic-review-of-on-label-and-off-label-use"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,19]]},"references-count":39,"URL":"https:\/\/doi.org\/10.7573\/dic.2025-9-4","relation":{},"ISSN":["1740-4398"],"issn-type":[{"value":"1740-4398","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,19]]},"article-number":"dic.2025-9-4"}}