Telavancin versus vancomycin for hospital-acquired pneumonia due to gram-positive pathogens

Ethan Rubinstein, Tahaniyat Lalani, G. Ralph Corey, Zeina A. Kanafani, Esteban C. Nannini, Marcelo G. Rocha, Galia Rahav, Michael S. Niederman, Marin H. Kollef, Andrew F. Shorr, Patrick C. Lee, Arnold L. Lentnek, Carlos M. Luna, Jean Yves Fagon, Antoni Torres, Michael M. Kitt, Fredric C. Genter, Steven L. Barriere, H. David Friedland, Martin E. Stryjewski

Research output: Contribution to journalArticlepeer-review

212 Scopus citations

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 alltreated 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.

Original languageEnglish
Pages (from-to)31-40
Number of pages10
JournalClinical Infectious Diseases
Volume52
Issue number1
DOIs
StatePublished - Jan 1 2011

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