title: Telavancin versus vancomycin for hospital-acquired pneumonia due to gram-positive pathogens.
abstract: BACKGROUND
  Telavancin is a lipoglycopeptide bactericidal against gram-positive pathogens.
  
  
  METHODS
  Two methodologically identical, double-blind studies (0015 and 0019) were conducted involving patients with hospital-acquired pneumonia (HAP) due to gram-positive pathogens, particularly methicillin-resistant Staphylococcus aureus (MRSA). Patients were randomized 1:1 to telavancin (10 mg/kg every 24 h) or vancomycin (1 g every 12 h) for 7-21 days. The primary end point was clinical response at follow-up/test-of-cure visit.
  
  
  RESULTS
  A total of 1503 patients were randomized and received study medication (the all-treated population). In the pooled all-treated population, cure rates with telavancin versus vancomycin were 58.9% versus 59.5% (95% confidence interval [CI] for the difference, -5.6% to 4.3%). In the pooled clinically evaluable population (n = 654), cure rates were 82.4% with telavancin and 80.7% with vancomycin (95% CI for the difference, -4.3% to 7.7%). Treatment with telavancin achieved higher cure rates in patients with monomicrobial S. aureus infection and comparable cure rates in patients with MRSA infection; in patients with mixed gram-positive/gram-negative infections, cure rates were higher in the vancomycin group. Incidence and types of adverse events were comparable between the treatment groups. Mortality rates for telavancin-treated versus vancomycin-treated patients were 21.5% versus 16.6% (95% CI for the difference, -0.7% to 10.6%) for study 0015 and 18.5% versus 20.6% (95% CI for the difference, -7.8% to 3.5%) for study 0019. Increases in serum creatinine level were more common in the telavancin group (16% vs 10%).
  
  
  CONCLUSIONS
  The primary end point of the studies was met, indicating that telavancin is noninferior to vancomycin on the basis of clinical response in the treatment of HAP due to gram-positive pathogens.
authors.affiliation: Section of Infectious Diseases Department of Internal Medicine and Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada. rubinste@cc.umanitoba.ca
authors.forename: Ethan
authors.initials: E
authors.lastname: Rubinstein
authors.forename: Tahaniyat
authors.initials: T
authors.lastname: Lalani
authors.forename: G Ralph
authors.initials: GR
authors.lastname: Corey
authors.forename: Zeina A
authors.initials: ZA
authors.lastname: Kanafani
authors.forename: Esteban C
authors.initials: EC
authors.lastname: Nannini
authors.forename: Marcelo G
authors.initials: MG
authors.lastname: Rocha
authors.forename: Galia
authors.initials: G
authors.lastname: Rahav
authors.forename: Michael S
authors.initials: MS
authors.lastname: Niederman
authors.forename: Marin H
authors.initials: MH
authors.lastname: Kollef
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Shorr
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Lee
authors.forename: Arnold L
authors.initials: AL
authors.lastname: Lentnek
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Luna
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Fagon
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
authors.forename: Michael M
authors.initials: MM
authors.lastname: Kitt
authors.forename: Fredric C
authors.initials: FC
authors.lastname: Genter
authors.forename: Steven L
authors.initials: SL
authors.lastname: Barriere
authors.forename: H David
authors.initials: HD
authors.lastname: Friedland
authors.forename: Martin E
authors.initials: ME
authors.lastname: Stryjewski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000617:Aminoglycosides / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D000077427:Lipoglycopeptides; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D008875:Middle Aged; D011023:Pneumonia, Staphylococcal / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use*
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D000077427:Lipoglycopeptides; D014640:Vancomycin; C487637:telavancin