Adult Dosing
Complicated Skin and Skin Structure Infections
- Start 10 mg/kg IV (over 60 mins) q24 hrs x 7-14 days
Hospital-acquired and ventilator-associated pneumonia
- Start 10 mg/kg IV (over 60 mins) q24 hrs x 7-21 days
Note: Duration of therapy varies by the severity and site of the infection and the patient’s clinical and bacteriological progress
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
Renal Dose Adjustment (Based on CrCl)
- >50 mL/min: 10 mg/kg IV q24 hrs
- 30-50 mL/min: 7.5 mg/kg IV q24 hrs
- 10 -
30 mL/min: 10 mg/kg q48 hrs - ESRD: Dose adjustments not defined
- HD: Dose adjustments not defined
- Note: Decreased efficacy in CrCl <50 mL/min
Hepatic Dose Adjustment
- Mild or moderate impairment: No dose adjustments
- Severe impairment: Dose adjustments not defined
- An increased mortality risk has been seen in patients with pre-existing moderate/severe renal impairment (CrCl 50 mL/min) receiving telavancin for hospital-acquired or ventilator-associated bacterial pneumonia vs vancomycin. Treatment with telavancin in such patients should only be considered if potential benefit outweighs potential risk [US Black Box Warning]
- New onset or worsening of renal impairment has been reported with telavancin use [US Black Box Warning]
- Perform serum pregnancy test at baseline; advise effective contraception in women with child bearing potential [US Black Box Warning]
- Avoid during pregnancy unless the potential benefits outweighs the potential risk for the fetus [US Black Box Warning]
- Serious hypersensitivity reactions, including anaphylactic reactions, some of which may be fatal have been reported following first or subsequent doses of telavancin. Discontinue therapy at first signs of hypersensitivity
- It is unknown if cross-reactivity to telavancin occurs in patients hypersensitive to vancomycin. Caution is advised in such patients
- Nephrotoxicity manifested as increases in serum creatinine, renal insufficiency, renal impairment, and/or renal failure has occurred. Increases in serum creatinine to 1.5 times baseline may occur. Adverse reactions are more likely to occur in patients with pre-existing renal disease, diabetes, CHF, hypertension, and in patients who take concomitant medications known to affect kidney function (eg, NSAIDs, ACE inhibitors, loop diuretics). Perform CrCl at baseline and q48-72h or more frequently if indicated, then at the end of therapy. If renal function decreases, consider alternative agent based on risk benefit analysis
- Decreased efficacy in patients with moderate/severe baseline renal impairment
- To reduce the development of drug-resistant bacteria and maintain the effectiveness, administer telavancin only to treat infections that are proven or strongly suspected to be caused by susceptible bacteria
- Rapid IV infusion can cause "red man syndrome"–like reactions; administer over 60 mins to reduce risk of infusion related reactions (flushing of the upper body, urticaria, pruritus, or rash)
- Avoid in patients with congenital long QT syndrome, known prolongation of the QTc, uncompensated heart failure, or severe left ventricular hypertrophy
- Interferes with laboratory coagulation tests, including prothrombin time, international normalized ratio, and activated partial thromboplastin time
- Monitor for bacterial or fungal superinfections during therapy
- Clostridium difficile-associated diarrhea (CDAD), ranging in severity from mild diarrhea to fatal colitis has been reported; consider CDAD in patients with diarrhea following antibiotic use
Cautions: Use cautiously in
- Renal impairment
- Concurrent QT prolonging agents
- Concurrent nephrotoxic agents
- CHF
- Hypertension
- Diabetes mellitus
- Elderly patients
Pregnancy Category:C
Breastfeeding: Safety unknown; manufacturer advises caution.
