Telavancin

Telavancin is a semisynthetic lipoglycopeptide antibiotic derived from vancomycin and marketed under the brand name Vibativ. It inhibits cell wall synthesis by binding to the D-Ala-D-Ala termini and disrupts membrane potential via its lipophilic side chain, producing rapid bactericidal activity against many Gram-positive pathogens, including MRSA. It has limited activity against Gram-negatives.

Indications: In adults, telavancin is approved for complicated skin and skin structure infections caused by susceptible Gram-positive organisms, and for hospital-acquired pneumonia, including ventilator-associated pneumonia, due to susceptible organisms. It is not indicated for pediatric use.

Administration and pharmacokinetics: Telavancin is administered intravenously, typically once daily depending on indication. The elimination half-life is several hours, and the drug is primarily excreted unchanged in the urine, necessitating dose adjustment in renal impairment. It is a concentration-dependent antibiotic with bactericidal activity.

Safety and adverse effects: Telavancin is associated with nephrotoxicity and fetal risk; it carries pregnancy Category C and should be avoided in pregnancy unless benefits outweigh risks. Other notable adverse effects include QT interval prolongation, infusion-related reactions, taste disturbance, and elevations in hepatic enzymes. Caution is advised with coadministration of nephrotoxic or QT-prolonging agents; monitor renal function, electrolytes, and liver tests during therapy.

Regulatory and resistance notes: Resistance is uncommon but possible through vancomycin-intermediate mechanisms; susceptibility testing guides use. Telavancin’s safety profile has led to boxed warnings and restricted use in certain patient populations.