Telavancin was the first approved lipoglycopeptide for the treatment of skin and soft-tissue infection due to resistant gram-positive bacterial pathogens. It is indicated as an alternative to vancomycin in skin and soft-tissue infection and hospital-acquired and ventilator-associated bacterial pneumonia. Telavancin displays concentration-dependent bactericidal killing and a 7.5-hour half-life and post-antibiotic effect of 4–6 hours allowing for once-daily dosing. Taste disturbance, nausea, headache, foamy urine, prolonged QT, and reversible kidney injury are the most commonly observed adverse events. Telavancin has a boxed warning highlighting the increased mortality in patients with preexisting kidney dysfunction (creatinine clearance 50 mL/min or less). Similar to daptomycin and linezolid, telavancin is useful in the treatment of resistant bacterial infection as an alternative for patients who are intolerant of vancomycin. However, the increased mortality risk in certain patients suggests it should serve a secondary role in the treatment of serious gram-positive infection.
Dalbavancin is a longer acting lipoglycopeptide similar to telavancin with similar spectrum of activity but does not prolong the QT interval. The recommended dosage is 1000 mg administered once followed by 500 mg 1 week later; dosage reduction should take place for patients with creatinine clearance less than 30 mL/min. In the treatment of acute bacterial skin and skin structure infection, a single intravenous 1500 mg dose of dalbavancin appears to be equal to the weekly administered medication. Dalbavancin has also shown efficacy and safety in the treatment of osteomyelitis at a dose of 1500 mg given once weekly for two doses.
Oritavancin is also a lipoglycopeptide with a particularly long pharmacologic half-life, such that a single dose of 1200 mg is equal to vancomycin in the treatment of acute bacterial skin infections. Oritavancin is significantly more active than telavancin or dalbavancin against VRE. While all three of these lipoglycopeptides are useful in the treatment of acute skin and skin-structure infection, their efficacy in the treatment of more serious infection has not been determined.
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