Vibativ Disease Interactions

Clostridioides difficile-associated diarrhea (CDAD), formerly pseudomembranous colitis, has been reported with almost all antibacterial drugs and may range from mild diarrhea to fatal colitis. The most common culprits include clindamycin and lincomycin. Antibacterial therapy alters the normal flora of the colon, leading to overgrowth of C difficile, whose toxins A and B contribute to CDAD development. Morbidity and mortality are increased with hypertoxin-producing strains of C difficile; these infections can be resistant to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea after antibacterial use. Since CDAD has been reported to occur more than 2 months after antibacterial use, careful medical history is necessary. Therapy with broad-spectrum antibacterials and other agents with significant antibacterial activity should be administered cautiously in patients with history of gastrointestinal disease, particularly colitis; pseudomembranous colitis (generally characterized by severe, persistent diarrhea and severe abdominal cramps, and sometimes associated with the passage of blood and mucus), if it occurs, may be more severe in these patients and may be associated with flares in underlying disease activity. Antibacterial drugs not directed against C difficile may need to be stopped if CDAD is suspected or confirmed. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C difficile, and surgical evaluation should be started as clinically indicated.

Telavancin can cause QT prolongation, which may lead to an increased risk for ventricular arrhythmias, including Torsade de Pointes. Use of telavancin should be avoided in patients with congenital long QT syndrome, known prolongation of the QTc interval, uncompensated heart failure, or severe left ventricular hypertrophy.

Telavancin does not interfere with coagulation, it interfered with certain tests used to monitor coagulation. It is recommended to collect blood samples for coagulation tests as close as possible prior to a patient's next dose of telavancin or to consider a non-phospholipid dependent coagulation test such as a Factor Xa (chromogenic) assay or an alternative anticoagulant not requiring aPTT monitoring for those patients requiring aPTT monitoring.

No dosage adjustment is recommended in patients with mild or moderate hepatic impairment. The pharmacokinetics of telavancin have not been evaluated in patients with severe hepatic impairment. Caution and close monitoring should be exercised when administering telavancin to patients with severe hepatic impairment.

Telavancin may increase the risk of nephrotoxicity in patients predisposed to kidney dysfunction (preexisting renal disease, diabetes mellitus, congestive heart failure, or hypertension) and in those taking medications known to affect kidney function. It is recommended to monitor renal function (i.e., serum creatinine, creatinine clearance) prior to initiation of therapy, during treatment, and at the end of treatment in all patients receiving telavancin; and if renal function decreases, the benefit of continuing therapy versus discontinuing and initiating therapy with an alternative agent should be assessed.

Use of telavancin in patients with preexisting moderate/severe renal impairment should be considered only when the anticipated benefit to the patient outweighs the potential risk. Dosage adjustment is required in patients with <=50 mL/min renal impairment. There is insufficient information to make specific dosage adjustment recommendations for patients with end-stage renal disease (CrCl <10 mL/min), including patients receiving hemodialysis. Serum creatinine should be closely monitored and, if renal toxicity is suspected, an alternative agent should be considered.