Use of Telavancin for the Treatment of Methicillin-Resistant Staphylococcus aureus-Associated Pulmonary Exacerbations in Patients with Cystic Fibrosis: a Retrospective Case Series

Background: Cystic Fibrosis (CF) patients with methicillin-resistant Staphylococcus aureus (MRSA) experience a more rapid decline in lung function, increased antibiotic use, increased hospitalization and decreased survival. Current CF Foundation’s Pulmonary Therapies Committee does not make specific treatment recommendations for patients experiencing MRSA-associated pulmonary exacerbations. While expert opinion and current prescribing trends favor vancomycin and linezolid, alternative therapies are needed due to drug intolerances and treatment experience. The objective of this study is to describe the use of telavancin for the treatment of CF patients hospitalized for MRSA-associated pulmonary exacerbations.

Methods: A retrospective electronic chart review of CF patients hospitalized for MRSA-associated pulmonary exacerbations and treated with telavancin was conducted between 1 January 2014 and 31 December 2015. Treatment was considered to be successful if telavancin was completed as planned or did not require a change in anti-MRSA therapy. Response to therapy was defined as recovery of greater than or equal to 90 percent of baseline FEV1 at conclusion of therapy. Safety was evaluated by tolerance of treatment. This study was approved by the local institutional review board.

Results: Twelve patients had a total of 19 different hospitalizations where telavancin was used for treatment of an MRSA-associated pulmonary exacerbation. Telavancin treatment was successfully completed in 13 (68%) of the 19 treatment courses. Response to therapy could be assessed in 9 of the 13 completed courses of therapy, with 6 (67%) meeting the pre-specified definition of response. Overall, adverse events occurred in 8 (42%) of 19 treatment courses, with 2 leading to drug discontinuation. The most comment adverse events were pruritus and acute kidney injury, each occurring in 3 treatment courses.

Conclusion: Although more research is needed, telavancin may be a possible treatment alternative when treating CF patients with MRSA-associated pulmonary exacerbations.