Abstract
Purpose
The purpose of this comparative review is to provide clinical information on the semisynthetic
lipoglycopeptides (telavancin, oritavancin, and dalbavancin) for the management of
gram-positive infections.
Methods
A PubMed search was conducted using the following terms: telavancin, dalbavancin, and oritavancin. Clinical trials evaluating pharmacokinetic properties, pharmacodynamic properties,
clinical efficacy, and safety profiles were included in the review.
Findings
The lipoglycopeptides are approximately 4- to 8-fold more potent than vancomycin against
gram-positive organisms, including activity against vancomycin-intermediate or vancomycin-resistant
strains of Staphylococcus and Enterococcus species. In addition, oritavancin maintains activity against Enterococcus species harboring vanA operon. Clinical trial data revealed equal efficacy to vancomycin
in the management of acute bacterial skin and skin structure infections and, in the
case of telavancin, hospital-acquired pneumonia. A benefit of oritavancin and dalbavancin
is that a full course of therapy consists of a single- or 2-dose regimen, respectively.
These agents are well tolerated with similar adverse event rates to vancomycin. Telavancin
requires a thorough assessment before initiation of therapy to minimize the risk of
acute kidney injury and teratogenicity.
Implications
The lipoglycopeptides enhance the antibiotic gram-positive armamentarium at a time
when methicillin-resistant Staphylococcus aureus prevalence and overall resistance is at an all-time high. These agents serve to fill
different clinical roles in the management of gram-positive infections. On the basis
of the available data, telavancin should be considered a plausible agent for the management
of gram-positive organisms when patients do not respond or develop adverse effects
to vancomycin. Dalbavancin and oritavancin are new therapeutic options, and their
potency and pharmacokinetic properties may provide benefit over existing therapies.
Clinical trial data indicate that patients with signs or symptoms of skin and skin
structure infections may be successfully treated using 1 or 2 doses of these agents.
Eliminating the need for inpatient admission, central catheter placement, and/or daily
outpatient parenteral antibiotic therapy is a major advance in treatment of skin and
skin structure infections. This strategy may reduce costs associated with resource
utilization and iatrogenic morbidity, resulting in overall improvements in care.
Key words
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Article Info
Publication History
Published online: December 03, 2015
Accepted:
November 13,
2015
Identification
Copyright
© 2015 Elsevier HS Journals, Inc. Published by Elsevier Inc. All rights reserved.
