Telavancin for refractory MRSA bacteraemia in intermittent haemodialysis recipients

Britt, Nicholas S.; Tirmizi, Samad; Ritchie, David J.; Topal, Jeffrey; McManus, Dayna; Nizet, Victor; Casabar, Ed; Sakoulas, George

doi:10.1093/jac/dkx437

Cited by 11 publications

(12 citation statements)

References 5 publications

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“…Telavancin primarily undergoes elimination via the kidneys with 76% found in the urine as unchanged drug, thus dose adjustments are necessary when creatinine clearance falls below 50 ml/min (34). No dosing recommendations are formally provided in the product labeling for hemodialysis; however, every 48 hours or thrice-weekly dosing regimens were found to be effective in a small retrospective case series (35). At present, black box warnings are issued for telavancin regarding nephrotoxicity and increased mortality in patients with preexisting moderate/severe impaired kidney function (creatinine clearance ,50 ml/min) who are being treated for hospital-acquired or ventilatorassociated bacterial pneumonia (34).…”

Section: Lipoglycopeptidesmentioning

confidence: 99%

Clinical Pharmacology of Antibiotics

Eyler

Shvets

2019

CJASN

134

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Antimicrobial pharmacology and its effect on prescribing is quite complex. Selecting an antibiotic that will optimally treat an infection while minimizing adverse effects and the development of resistance is only the first step, as one must also consider the patient's individual pharmacokinetic alterations and the pharmacodynamic properties of the drug when prescribing it as well. Patients with CKD may have alterations in their protein binding, volumes of distribution, kidney clearance, and nonrenal clearance that necessitates antibiotic dose adjustments to prevent the development of toxicity. Knowledge of a drug's pharmacodynamics, defined as the relationship between drug exposure and antibacterial efficacy, provides some guidance regarding the optimal way to make dose adjustments. Different pharmacodynamic goals, such as maximizing the time that free (unbound) drug concentrations spend above the minimum inhibitory concentration (MIC) for time dependent drugs (e.g., b-lactams) or maximizing the free peak-to-MIC ratio for concentration-dependent antibiotics (e.g., aminoglycosides), require different adjustment strategies; for instance, decreasing the dose while maintaining normal dosing frequency or giving normal (or even larger) doses less frequently, respectively. Patients receiving hemodialysis have other important prescribing considerations as well. The nephrologist or patient may prefer to receive antibiotics that can be administered intravenously toward the end of a dialysis session. Additionally, newer dialysis technologies and filters can increase drug removal more than originally reported. This review will discuss the place in therapy, mechanism of action, pharmacokinetic, pharmacodynamic, and other pharmacologic considerations encountered when prescribing commonly used antibiotics in patients with chronic kidney disease or ESKD.

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Section: Lipoglycopeptidesmentioning

confidence: 99%

Clinical Pharmacology of Antibiotics

Eyler

Shvets

2019

CJASN

134

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“…Median duration of bacteremia was significantly shorter following switch to telavancin therapy (1 day) compared with antibiotic therapy preceding telavancin (16 days). No adverse events were noted in this study [ 27 ].…”

Section: Resultsmentioning

confidence: 98%

“…The FDA prescribing information for telavancin does not provide a recommended dosing strategy for telavancin in the setting of IHD, noting insufficient data. However, in recent years several studies have sought to describe potential dosing strategies for this patient population and provide preliminary support for the use of telavancin in thrice-weekly post-IHD dosing [ 25 – 27 ].…”

Section: Resultsmentioning

confidence: 99%

“…Based on the exposure profile of telavancin in ESRD, the available PK data appear to support the feasibility of thrice-weekly post-IHD telavancin dosing. However, clinical data are extremely limited and dialyzer types were either low-flux or unreported [ 25 – 27 ]. The optimal dosing of telavancin following high-flux IHD remains unknown and the safety profile of telavancin dosing with IHD is poorly characterized.…”

Section: Resultsmentioning

confidence: 99%

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Post-Dialysis Parenteral Antimicrobial Therapy in Patients Receiving Intermittent High-Flux Hemodialysis

Cimino

Burnett

Vyas

et al. 2021

Drugs

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Patients with end-stage renal disease (ESRD) requiring intermittent hemodialysis (IHD) are at increased risk of infection, which represents a leading cause of mortality in this population. The use of additional vascular access devices such as peripherally inserted central catheters to treat such infections should be minimized in patients with ESRD requiring IHD in order to mitigate complications such as infection and thrombosis and to maintain venous patency for hemodialysis access. Intravenous antimicrobial dosing following IHD has the advantages of avoiding additional access devices and providing convenience for patients and providers. Vancomycin, cefazolin, and aminoglycosides have historically been regarded as the primary intravenous antimicrobials administered with IHD given their relatively low cost, convenient dosing, and longevity of clinical use. Despite this, a growing body of literature is evaluating the use of an expanded list of antimicrobials that may be employed using post-dialysis dosing for patients requiring IHD; however, the available data are largely limited to pharmacokinetic studies and small cohorts of infected patients or uninfected subjects. Post-dialytic dosing of intravenous antimicrobials may be considered on a patient-by-patient basis after careful consideration of clinical, microbiological, and logistical factors that may influence the probability of treatment success. This document reviews and evaluates currently available information on the post-dialytic administration of an expanded list of intravenous antimicrobials in the setting of thrice-weekly, high-flux IHD.

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“…74 A case series of 14 patients with persistent MRSA bacteraemia failing vancomycin or daptomycin were treated with telavancin Microbiological clinical cure was achieved in 7/8 (87.5%) with a median duration of bacteraemia of 1 day (range 0-11 days). 76 It should be noted that telavancin demonstrated higher rates of nephrotoxicity and increased rates of mortality in patients with reduced renal function compared to vancomycin, leading to a boxed warning for nephrotoxicity and for use in patients with CrCl <50 mL/min. 77 Lower doses (7.5 mg/kg daily) appear to be equal in efficacy in vitro to the FDA-approved dose of 10 mg/kg daily.…”

Section: Telavancinmentioning

confidence: 99%

Treatment strategies for persistent methicillin‐resistantStaphylococcus aureusbacteraemia

et al. 2018

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Telavancin for refractory MRSA bacteraemia in intermittent haemodialysis recipients

Abstract: Telavancin was very safe and highly effective in the treatment of refractory MRSA-B in a cohort of patients with ESRD requiring IHD. These data support the utility of telavancin in the armamentarium against refractory MRSA-B, particularly in the high-risk IHD-dependent population.

Cited by 11 publications

References 5 publications

Clinical Pharmacology of Antibiotics

Clinical Pharmacology of Antibiotics

Post-Dialysis Parenteral Antimicrobial Therapy in Patients Receiving Intermittent High-Flux Hemodialysis

Treatment strategies for persistent methicillin‐resistantStaphylococcus aureusbacteraemia

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