Telavancin (Vibativ). A vancomycin derivative, no more effective but more toxic.

When bacterial pneumonia contracted in hospital (nosocomial pneumonia) is thought to be due to a methicillin-resistant strain of S. aureus, the most commonly used antibiotics are vancomycin and teicoplanin (glycopeptides) or linezolid (an oxazolidinone). Telavancin, a glycopeptide derived from vancomycin, is active in vitro against methicillin-resistant S. aureus. It has been authorised in the European Union for second-line treatment of patients with nosocomial pneumonia caused by methicillin-resistant S. aureus. Telavancin has not been tested in nosocomial pneumonia resistant to first-line antibiotics. There is no evidence that its antibacterial efficacy is better than that of existing options. In two randomised trials including a total of 1532 patients with nosocomial pneumonia, telavancin and vancomycin yielded similar cure rates, including in cases due to methicillin-resistant S. aureus. Higher mortality rates were reported in the telavancin group, especially among patients with renal impairment. Telavancin causes more renal adverse effects and QT prolongation than vancomycin. The other known adverse effects of telavancin are shared by vancomycin. Cases of cross-allergy between the two drugs have been reported. Telavancin is both nephrotoxic and eliminated by the kidneys, creating a risk of interactions with other nephrotoxic drugs and accumulation in patients with renal impairment. Telavancin can interfere with some clotting tests. Telavancin was teratogenic in experimental animals. In practice, there is no evidence that telavancin is more effective than vancomycin, but it has more adverse effects. It is has not been shown to be effective on infections due to bacteria resistant to vancomycin, teicoplanin or linezolid. It is better not to use telavancin, but rather continue to use standard antibiotics appropriately.