Telavancin (VIBATIV) for the treatment of complicated skin and skin structure infections

Abstract

Methicillin-resistant Staphylococcus aureus has emerged as a major causative pathogen in complicated skin and skin structure infections (cSSSIs). Unfortunately, treatment failure with vancomycin has been increasingly reported. Over the past decade, several alternative antimicrobial agents have been studied and approved for the treatment of cSSSIs. One such agent is the lipoglycopeptide telavancin, which was approved by the US FDA 2009. Given its dual mechanism of action, telavancin is characterized by a highly bactericidal activity and low potential for resistance selection. In addition, in clinical trials, it was efficacious and safe in the treatment of cSSSI. The purpose of this review is to give a background overview of telavancin, highlighting its microbiological, pharmacokinetic and pharmacodynamics characteristics, to summarize the available evidence for its use in the treatment of cSSSIs, and to provide an updated evaluation of its safety profile.

Keywords:

• complicated skin and skin structure infection
• lipoglycopeptide
• methicillin-resistant S. aureus
• telavancin
• vancomycin

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Telavancin is a rapidly bactericidal lipoglycopeptide.

• Telavancin has a dual mechanism of action through inhibition of cell-wall synthesis and disruption of bacterial cell membrane barrier.

• Telavancin is bactericidal against Staphylococcus aureus regardless of methicillin resistance, streptococci, enterococci (vancomycin-resistant and sensitive) and retains activity against vancomycin-resistant Staphylococcus aureus.

• Telavancin has a long serum half-life allowing once daily intravenous dosing and exhibits prolonged post-antibiotic effect.

• Phase II and III trials have demonstrated that telavancin is non-inferior to standard therapy in the treatment of complicated skin and skin structure infections.

• Collective data from clinical trials suggest that telavancin is well tolerated and has a favorable safety profile in most patient populations.

• In patients with renal impairment and in pregnant women, telavancin should only be used when benefits outweigh the risks.