Retrospective case series includes adult patients admitted from 2010-2016 who received at least three doses of telavancin. Data collection includes patient demographics, telavancin dosing, antibiotic indication, length of stay, laboratory and microbiological data, and case mix index (CMI). The primary outcome is to assess the efficacy of capping telavancin doses at 750 mg compared to non-capped doses. Secondary outcomes include safety and financial outcomes, as well as readmission rates.
333 patients were evaluated with 164 meeting the inclusion criteria. 73 patients in the capped group vs 91 in the non-capped group. Most common infections included ABSSI, pneumonia and bacteremia. Mean weight 110 kg in capped vs 108 kg in noncapped, mean age 52 vs 58, male 63% vs 70%, fever resolution 83% vs 60%, CMI 3.19 vs 3.43 Six patients (8.2%) in the capped group were readmitted and 6 (8.5%) needed additional antibiotics compared to 12 (13.2%) and 9 (9.9%) in the non-capped group, respectively. Seven (9.6%) patients in the capped group experienced nephrotoxicity compared to 21 (23.1%) in the non-capped group (p=0.04). The capped group experienced 7 (9.6%) incidents of mortality vs 28 (30.8%) in the non-capped group (p=0.001). When doses were capped, approximately $1,400 was saved per patient.
The use of a capped 750 mg telavancin dose in adult patients appears to be an alternative dosing scheme that maintains efficacy and safety as well as being associated with reduced cost. Additional pharmacokinetic and clinical studies are needed to further investigate the use of capped dosing of telavancin to support the findings of this retrospective case series.
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