Telavancin: a Promising Weapon against Antimicrobial Resistance

Antimicrobial resistance threatens the clinical effectiveness of many current antimicrobials, while jeopardizing important advances being made against major infections. This has led the World Health Organisation (WHO) to adopt Antimicrobial resistance as its theme for World Health Day 2011. While rational prescribing practices will help decrease the problem of resistance, we must have reserve drugs in our hands to fight this ever-increasing menace.

Over the past few years, there has been an intensified focus on the emergence of methicillin-resistant Staphlococcus aureus (MRSA), including both community-acquired and hospital-acquired strains, against which vancomycin became the drug of choice. Increased frequency of staphylococcal and enterococcal resistance to vancomycin has prompted a search for newer anti-MRSA agents.

Telavancin, a semi-synthetic derivative of vancomycin, was approved in September 2009 by the FDA for the treatment of complicated skin and skin structure infections, (cSSSI), caused by susceptible gram-positive bacteria, especially methicillin-resistant S. aureus (MRSA). It is also being proposed for treatment of nosocomial pneumonia, with focus on MRSA infections.

Major advantage of telavancin over vancomycin is its therapeutic potential against vancomycin-resistant organisms, including vancomycin-resistant enterococci and vancomycin-resistant S. aureus (VRSA). Telavancin inhibits bacterial cell wall synthesis and is ten times more active than vancomycin in this respect. However, unlike vancomycin, which has a slow, primarily bacteriostatic action telavancin demonstrates rapidly bactericidal properties. It also disrupts bacterial cell membrane potential and increases permeability and outflow of essential ions. It shows considerable penetration into skin blister fluid, thus accounting for its use in cSSSIs. With predictable and linear pharmacokinetic profile and low level of resistance against it, telavancin is a welcome addition to the clinicians' armoury in the fight against antimicrobial resistance.