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* This is the Professional Version. *

Telavancin

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Patient Education

Telavancin is a semisynthetic lipoglycopeptide derivative of vancomycin that has bactericidal activity exclusively against gram-positive bacteria. Telavancin inhibits cell wall synthesis and disrupts cell membrane integrity.

Pharmacology

Parenteral telavancin penetrates well into pulmonary epithelial lining fluid and skin blisters.

Telavancin has a half-life of 7 to 9 h and a postantibiotic effect of about 4 h.

Telavancin is excreted by the kidneys so the dose must be adjusted in patients with renal insufficiency.

Indications

Telavancin is active against gram-positive bacteria such as

  • Streptococci

  • Enterococcus faecalis

  • E. faecium

  • Staphylococcus aureus, including S. aureus that is methicillin-resistant or vancomycin–intermediate-resistant

Telavancin is used for complicated skin and skin structure infections as well as for hospital-acquired and ventilator-acquired bacterial pneumonia caused by sensitive isolates of S. aureus. Outcome may be worse for patients with baseline moderate to severe renal insufficiency.

Contraindications

Telavancin is contraindicated in patients who are allergic to it. It should be used with care in patients who are allergic to vancomycin because cross-reactivity is possible.

Use During Pregnancy and Breastfeeding

Telavancin has had adverse effects on fetal development in animals, and there are no safety data in pregnant women to generate category C labeling.

There are no data regarding excretion in breast milk.

Adverse Effects

Common adverse effects include

  • Nausea and vomiting

  • Taste disturbance

  • Foamy urine

Telavancin also interferes with certain coagulation and urine protein assays.

Significant adverse effects include

  • A histamine-mediated pruritus and flushing of the face, neck, and shoulders, similar to the red-person syndrome that can occur with vancomycin

  • Nephrotoxicity, which may occur slightly more often with telavancin than with vancomycin

  • QTc prolongation

Pruritus and flushing can be prevented by infusing the drug over ≥ 60 min.

QTc prolongation occurred in healthy subjects in the clinical trials of telavancin; thus, telavancin should be used with caution or not be used in patients taking drugs that prolong the QT interval. Telavancin should not be used in patients with congenital long QT syndrome, known QTc prolongation, uncompensated heart failure, or severe left ventricular hypertrophy (patients with these disorders were excluded from the clinical trials).

Dosing Considerations

Telavancin dosing is based on creatinine clearance:

  • Creatinine clearance > 50 mL/min: 10 mg/kg IV q 24 h

  • Creatinine clearance 30 to 50 mL/min: 7.5 mg/kg q 24 h

  • Creatinine clearance 10 to < 30 mL/min: 10 mg/kg q 48 h

  • Creatinine clearance < 10 mL/min: Data limited, no recommendations available

* This is the Professional Version. *