Telavancin versus vancomycin for hospital-acquired pneumonia due to gram-positive
pathogens.
Author(s): 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 JY, Torres
A, Kitt MM, Genter FC, Barriere SL, Friedland HD, Stryjewski ME; ATTAIN Study
Group.
Affiliation(s): Section of Infectious Diseases Department of Internal Medicine and Medical
Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada.
rubinste@cc.umanitoba.ca
Publication date & source: 2011, Clin Infect Dis. , 52(1):31-40
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.
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