Another Option, With Caveats
Since its initial US Food and Drug Administration approval in 2009 for complicated skin and skin structure infections, telavancin has had limited use, most likely because of narrow indications, perceived safety and tolerance issues, and marketing challenges. This challenge continued even after an approval for hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia (including methicillin-susceptible and methicillin-resistant Staphylococcus aureus) when the label limited use to situations with no suitable alternative agents. It is often necessary to use antimicrobials for off-label uses when circumstances dictate that no other reasonable options are available. Saravolatz et al1 describe their analysis of real-world use of telavancin in an arena that has had limited use, S. aureus bacteremia. Analysis suggests that telavancin may be a reasonable choice in these patients. This is reassuring, as the compound's safety is better understood but still met with skepticism. Acceleration of approvals combating resistant pathogens, although welcome, does raise the potential for unanticipated adverse effects as well as prohibitive acquisition costs, and unfortunately, the physicians, facilities, and caregivers who care for the bulk of patients who often require therapy with agents like these face reimbursement and acquisition cost as disincentives to use. The return on investment of an individual drug is often not considered in the cost of total care and may lead to less optimal selections. Telavancin has similar spectrum to other agents and has been largely relegated to alternative therapy. Although it does not carry an indication for bacteremia, telavancin fills a therapy niche, but use by indications or not, use as a primary or alternative agent, real-world issues such as formulary restrictions, insurance limitations, and cost continue to deter use when other more frequently utilized, less costly, equally safe, and efficacious options are available.
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1. Saravolatz LD, Cleveland KO, Rikabi R, et al. A retrospective case series of telavancin for the treatment of Staphylococcus aureus
bacteremia: a real world experience. Infect Dis Clin Pract