USE OF TELAVANCIN IN ADOLESCENT PATIENTS WITH CYSTIC FIBROSIS AND PRIOR INTOLERANCE TO VANCOMYCIN: A CASE SERIES
Adam T. Bernsteina, Margaret W. Leighb, Jennifer L. Goralskib,c, Charles R. Esther Jrb, Cameron J. McKinziea
aDepartment of Pharmacy, University of North Carolina Medical Center, 101 Manning Drive, Campus Box 7600, Chapel Hill, North Carolina, 27514
bDivision of Pediatric Pulmonology, Department of Pediatrics, University of North Carolina School of Medicine, 450-D MacNider Hall, Campus Box 7217, Chapel Hill, North Carolina, 27599-7217
cDivision of Pulmonary and Critical Care Medicine, Department of Medicine, University of North Carolina School of Medicine, 125 MacNider Hall, Campus Box 7005, Chapel Hill, North Carolina, 27599-7005
What was your research question?
This was a descriptive report of three individuals who received the antibiotic telavancin for a cystic fibrosis (CF) exacerbation due to previous intolerances or allergies to standard antibiotic treatments.
Why is this important?
Children with CF may have limited therapy options due to medication intolerances and allergies. Telavancin can be effective for specific bacteria that cause pneumonia, but it lacks information for use in children and CF in general. Additionally, patients with a previous reaction to the antibiotic vancomycin may be more susceptible to reactions with telavnacin because the medications are similar in structure. This report may serve as a reference to health care providers who treat patients with intolerances to standard antibiotic regimens and motivate future research.
What did you do?
Three adolescent patients with previous reactions to vancomycin received telavancin on five separate occasions.
What did you find?
A complete course of telavancin was tolerated two out of the five times it was prescribed. One patient with a severe allergy to vancomycin had a reaction to telavancin despite only receiving a test dose that was 10% of the full therapeutic dose.
What does this mean and reasons for caution?
This is an anecdotal report of only three patients, therefore broad conclusions cannot be determined. Telavancin does not currently have strong data to support its use in adolescent patients with CF and should only be considered when standard therapies are not viable. If used in patients with previous reactions to vancomycin, providers should monitor for cross-reactivity.
Trials are still needed to determine the optimal dose of telavancin in paediatric patients and those with CF. Once this is known, large controlled trials are necessary to determine if telavancin is safe and effective for pneumonia in this patient population.