title: The clinical positioning of telavancin in Europe.
abstract: Telavancin was the first marketed lipoglycopeptide. Although licensed in Europe in 2011 for the treatment of nosocomial pneumonia caused by meticillin-resistant Staphylococcus aureus (MRSA), it did not become clinically available until March 2014. Given the limited clinical experience with telavancin in Europe, this review provides an overview of its antimicrobial and clinical activity as well as its position among today's antimicrobials, with particular focus on the implications of its licensing requirements. Telavancin has potent in vitro activity against isolates of Gram-positive pathogens, including MRSA and glycopeptide-intermediate S. aureus strains. In addition, at clinically attainable doses telavancin inhibits Gram-positive isolates of antibiotic-resistant strains from biofilm models. The in vitro potency of telavancin has been corroborated in the clinical setting. Comparative clinical studies of telavancin demonstrate non-inferiority compared with vancomycin in the treatment of hospital-acquired Gram-positive pneumonia, with high cure rates for telavancin-treated patients with monomicrobial S. aureus infection, including isolates with reduced vancomycin susceptibility. These studies also demonstrate an overall similar safety profile for telavancin and vancomycin, although importantly, patients with moderate-to-severe renal impairment at baseline are at greater risk for mortality with telavancin and this feature must be taken into account when selecting patients for its usage. In Europe, telavancin is a useful alternative for patients with difficult-to-treat, hospital-acquired MRSA pneumonia when there are very few alternatives. For example, it should be considered in such patients when vancomycin and linezolid are not suitable and where renal function permits.
authors.affiliation: Institute of Healthcare Associated Infection, University of the West of Scotland, University Hospital Crosshouse, 56A Lister Street, Kilmarnock KA2 0BB, UK. Electronic address: rgm@rgmconsulting.co.uk.
authors.forename: Robert
authors.initials: R
authors.lastname: Masterton
authors.affiliation: Department of Pathology and Diagnostics, University of Verona, Verona, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cornaglia
authors.affiliation: Unité des Agents Antibactériens, Institut Pasteur, Paris, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Courvalin
authors.affiliation: Institute for Clinical Pharmacology and Toxicology, Charité Universitätsmedizin Berlin, Freie Universität Berlin, Berlin, Germany.
authors.forename: Hartmut M
authors.initials: HM
authors.lastname: Lode
authors.affiliation: CIBERES & Universitat Autònoma de Barcelona and Critical Care Department, Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
authors.affiliation: Institut Clínic del Tórax (ICT), Servei de Pneumologia, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Ciber de Enfermedades Respiratorias, Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
mesh_terms: D000617:Aminoglycosides / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology; D005060:Europe; D006094:Gram-Positive Bacteria / Q000187:drug effects*; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology*; D006801:Humans; D000077427:Lipoglycopeptides
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D000077427:Lipoglycopeptides; C487637:telavancin
keywords: Gram-positive infections; Hospital-acquired pneumonia; MRSA; Nosocomial pneumonia; Telavancin