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telavancin (Vibativ)

Indications: - treatment of adult patients with complicated skin infections & skin structure bacterial infections caused by aerobic gram positive bacteria, including MRSA - Staphylococcal nosocomial pneumonia Contraindications: - caution in patients with renal insufficiency - decreased efficacy in patients with GFR < 90 mL/min - use alternative antibiotic when adverse reaction to vancomycin - hypersensitivity cross-reactivity with vancomycin is unknown Pregnancy category: C Dosage: - 10 mg/kg IV QD, infused over 60 minutes - duration of therapy: 7-14 days Injection: 250 & 750 mg vials for reconstitution; after reconstitution to a concentration of 15 mg/mL, it must be further diluted to a concentration of 0.6-8 mg/mL before administration Monitor: - renal function a) prior to treatment b) at least every 72 hours during treatment c) at the end of therapy Pharmacokinetics: - longer 1/2 life than vancomycin Antimicrobial activity: - gram positive aerobic bacteria, including MRSA - has lower minimal inhibitory activity to S aureus than vancomycin [3] - Staphylococcus aureus (including MRSA) - Streptococcus - Streptococcus pyogenes - Streptococcus agalactiae - Streptococcus anginosus group - Enterococcus faecalis (vancomycin-susceptible) Adverse effects: - taste disturbance, nausea, vomiting, & foamy urine are the most common side effects - may cause increases in serum creatinine (nephrotoxicity) [3] - may cause QT interval prolongation Drug interactions: - telavancin does not appear to induce or inhibit cyt P450 to a clinically relevant extent - possibly other drugs that prolong the QT interval (itraconazole, ondansetron, etc) - possibly other affect kidney function (NSAIDs, ACE inhibitors, etc) Test interactions: 1) telavancin can cause a false increase in coagulation tests a) prothrombin time, INR b) activated partial thromboplastin time c) activated clotting time d) coagulation based factor Xa tests) 2) does not affect actual coagulation 3) telavancin binds to a reagent used in anticoagulation tests Mechanism of action: - vancomycin analogue

General

antibacterial glycopeptide

Database Correlations

PUBCHEM correlations

References

  1. Prescriber's Letter 16(11): 2009 New Drug: Vibativ (Telavancin) Detail-Document#: 251117 (subscription needed) http://www.prescribersletter.com
  2. Leonard SN, Rybak MJ. Telavancin: an antimicrobial with a multifunctional mechanism of action for the treatment of serious gram-positive infections. Pharmacotherapy. 2008 Apr;28(4):458-68. PMID: 18363530
  3. Medical Knowledge Self Assessment Program (MKSAP) 16, 17. American College of Physicians, Philadelphia 2012, 2015
  4. Deprecated Reference
  5. Damodaran SE, Madhan S. Telavancin: A novel lipoglycopeptide antibiotic. J Pharmacol Pharmacother. 2011 Apr;2(2):135-7. PMID: 21772784 Free PMC Article