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

Journal Article (Journal Article)

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 all-treated 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.

Full Text

Duke Authors

Cited Authors

  • Rubinstein, E; Lalani, T; Corey, GR; Kanafani, ZA; Nannini, EC; Rocha, MG; Rahav, G; Niederman, MS; Kollef, MH; Shorr, AF; Lee, PC; Lentnek, AL; Luna, CM; Fagon, J-Y; Torres, A; Kitt, MM; Genter, FC; Barriere, SL; Friedland, HD; Stryjewski, ME; ATTAIN Study Group,

Published Date

  • January 2011

Published In

Volume / Issue

  • 52 / 1

Start / End Page

  • 31 - 40

PubMed ID

  • 21148517

Pubmed Central ID

  • PMC3060890

Electronic International Standard Serial Number (EISSN)

  • 1537-6591

International Standard Serial Number (ISSN)

  • 1058-4838

Digital Object Identifier (DOI)

  • 10.1093/cid/ciq031

Language

  • eng