Evaluation of telavancin dose capping in a large community hospital

BACKGROUND: Telavancin is a bactericidal lipoglycopeptide treat susceptible Gram-positive pathogens including Methicillin-resistant Staphylococcus aureus. Pharmacokinetic studies have shown that obese patients have increased exposure to telavancin compared with non-obese patients. Dose capping of 750 mg was utilized in selected patients with the purpose of minimizing toxicity and decreasing costs without compromising efficacy. METHODS: 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 with non-capped doses. Secondary outcomes include safety and financial outcomes, as well as readmission rates. RESULTS: 333 patients were evaluated with 164 meeting the inclusion criteria. Seventy-three 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 with 12 (13.2%) and 9 (9.9%) in the non-capped group, respectively. Seven (9.6%) patients in the capped group experienced nephrotoxicity compared with 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. CONCLUSION: 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. DISCLOSURES: All authors: No reported disclosures.