Vibativ

Generic Name: Telavancin Hydrochloride
Class: Glycopeptides
ATC Class: J01XA03
VA Class: AM900
Chemical Name: Vancomycin, N3″-[2-(decylamino)ethyl}-29-{[(phosphono-methyl)-amino]-methyl}-hydrochloride
Molecular Formula: C80H106C12N11O27P • xHCl (where x=1 to 3)
CAS Number: 380636-75-9

Warning(s)

  • Fetal Risk
  • Women of childbearing potential should have a serum pregnancy test to exclude pregnancy prior to administration of telavancin.1

  • Avoid use of telavancin during pregnancy unless potential benefits to the woman outweigh potential risks to the fetus.1

  • Concerns about potential adverse developmental outcomes in humans based on adverse developmental outcomes observed in 3 animal species given telavancin at clinically relevant doses during the period of organogenesis.1 (See Pregnancy under Cautions.)

REMS:

FDA approved a REMS for telavancin to ensure that the benefits outweigh the risks. The REMS may apply to one or more preparations of telavancin and consists of the following: medication guide and communication plan. See the FDA REMS page () or the ASHP REMS Resource Center ().

Introduction

Antibacterial; lipoglycopeptide; synthetic derivative of vancomycin.1 2 3 4 5

Uses for Vibativ

Skin and Skin Structure Infections

Treatment of complicated skin and skin structure infections caused by susceptible Staphylococcus aureus (including methicillin-resistant S. aureus [MRSA; also known as oxacillin-resistant S. aureus or ORSA]), Streptococcus pyogenes (group A β-hemolytic streptococci), S. agalactiae (group B streptococci), S. anginosus group (includes S. anginosus, S. intermedius, S. constellatus), or Enterococcus faecalis (vancomycin-susceptible strains only).1

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Indicated only for treatment of certain infections caused by certain gram-positive bacteria; if documented or presumed pathogens include gram-negative or anaerobic bacteria, concomitant use of another anti-infective may be clinically indicated.1

Vibativ Dosage and Administration

Administration

Administer by IV infusion.1

IV Infusion

For solution and drug compatibility information, see Compatibility under Stability.

Must be reconstituted and then further diluted prior to administration.1

Should not be admixed or added to solutions containing other drugs.1

If the same IV line is used for sequential infusion of other drugs, flush the IV line with 0.9% sodium chloride injection, 5% dextrose injection, or lactated Ringer's injection before and after the telavancin infusion.1

Reconstitution

Reconstitute vials containing 250 or 750 mg of telavancin with 15 or 45 mL, respectively, of 5% dextrose injection, sterile water for injection, or 0.9% sodium chloride injection to provide a solution containing 15 mg/mL.1

Discard vial if the vacuum is insufficient to pull diluent into vial.1

Mix thoroughly and ensure that drug has dissolved completely.1 Usually reconstitutes in <2 minutes, but reconstitution may take up to 20 minutes.1

Dilution

For doses of 150–800 mg, withdraw correct dose from the reconstituted vial and add to 100–250 mL of appropriate IV infusion fluid (i.e., 0.9% sodium chloride injection, 5% dextrose injection, lactated Ringer's injection).1

For doses <150 mg or >800 mg, withdraw correct dose from the reconstituted vial and add to a volume of appropriate IV infusion fluid (i.e., 0.9% sodium chloride injection, 5% dextrose injection, lactated Ringer's injection) that results in a final concentration of 0.6–8 mg/mL.1

Rate of Administration

Administer by IV infusion over 1 hour.1 Avoid rapid IV infusion.1 (See Infusion Reactions under Cautions.)

Dosage

Available as telavancin hydrochloride; dosage is expressed in terms of telavancin.1

Adults

Skin and Skin Structure Infections
IV

10 mg/kg once every 24 hours for 7–14 days.1

Duration of therapy based on severity and location of infection and patient's clinical and bacteriologic response.1

Special Populations

Hepatic Impairment

Dosage adjustment not needed in adults with mild to moderate hepatic impairment.1 8

Renal Impairment

Reduce dosage in adults with Clcr 10–50 mL/minute.1 Data insufficient to make dosage recommendations for adults with end-stage renal disease (Clcr <10 mL/minute), including those undergoing hemodialysis.1

Table 1. Telavancin Dosage for Adults with Renal Impairment1

Clcr Calculated Using Cockcroft-Gault Formula (mL/minute)

Telavancin Dosage

>50

10 mg/kg once every 24 hours

30–50

7.5 mg/kg once every 24 hours

10 to <30

10 mg/kg once every 48 hours

Geriatric Patients

Select dosage with caution because of age-related decreases in renal function.1 (See Geriatric Use under Cautions.)

Cautions for Vibativ

Contraindications

  • Manufacturer states none known.1

Warnings/Precautions

Warnings

Fetal/Neonatal Morbidity

Adverse developmental outcomes reported in 3 animal species given telavancin at clinically relevant doses during the period of organogenesis.1

Exclude pregnancy (negative serum pregnancy test) prior to initiation of telavancin in females of childbearing potential (i.e., those who have not had complete absence of menses for ≥24 months, medically confirmed menopause or primary ovarian failure, hysterectomy, bilateral oophorectomy, or tubal ligation).1

Use effective contraception to prevent pregnancy during treatment.1

Avoid use of telavancin during pregnancy unless potential benefits to the woman outweigh potential risks to the fetus.1 (See Pregnancy under Cautions.)

FDA required and approved a Risk Evaluation and Mitigation Strategy (REMS) for telavancin;17 goal of the telavancin REMS is to avoid unintended telavancin exposure in pregnant women by educating health-care providers and patients about potential risk of fetal developmental toxicity and recommended measures to exclude and prevent pregnancy.17 The REMS requires that a telavancin medication guide be provided to patient each time the drug is dispensed and outlines a communication plan requiring initial and periodic communications from manufacturer to certain targeted groups of prescribers and pharmacists.17

Nephrotoxicity

Renal impairment reported in patients receiving telavancin.1 In patients with normal baseline Scr concentrations, increased Scr (1.5 times baseline) reported more frequently in telavancin-treated patients than in vancomycin-treated patients.1

Adverse renal effects more likely in patients with conditions known to increase the risk of renal impairment (e.g., preexisting renal disease, diabetes mellitus, CHF, hypertension) and in those receiving concomitant therapy with an agent that affects renal function (e.g., NSAIAs, certain diuretics, ACE inhibitors).1

Monitor renal function (i.e., Scr, Clcr).1 Perform renal function tests prior to initiation of telavancin, every 48–72 hours during therapy (more frequently if indicated), and at end of therapy.1

If renal function decreases, weigh benefits of continuing telavancin versus discontinuing the drug and initiating an alternative anti-infective.1

Infusion Reactions

Rapid IV administration of glycopeptide anti-infectives (including telavancin) can result in a reaction referred to as the “red-man syndrome.”1 Flushing of the upper body, urticaria, pruritus, or rash may occur.1

To reduce risk of infusion-related reactions, give IV infusion over 1 hour.1 If an infusion reaction occurs, the reaction may cease if the infusion is discontinued or slowed.1

Superinfection/Clostridium difficile-associated Diarrhea and Colitis (CDAD)

Possible emergence and overgrowth of nonsusceptible organisms, including fungi.1 Monitor carefully; institute appropriate therapy if superinfection occurs.1

Treatment with anti-infectives alters normal colon flora and may permit overgrowth of Clostridium difficile.1 12 14 15 C. difficile infection (CDI) and C. difficile-associated diarrhea and colitis (CDAD; also known as antibiotic-associated diarrhea and colitis or pseudomembranous colitis) have been reported with nearly all anti-infectives and may range in severity from mild diarrhea to fatal colitis.1 12 C. difficile produces toxins A and B which contribute to development of CDAD;12 hypertoxin-producing strains of C. difficile are associated with increased morbidity and mortality since they may be refractory to anti-infectives and colectomy may be required.1

Consider CDAD if diarrhea develops during or after therapy and manage accordingly.1 12 14 15 Obtain careful medical history since CDAD may occur as late as ≥2 months after anti-infective therapy is discontinued.1

If CDAD is suspected or confirmed, discontinue anti-infectives not directed against C. difficile whenever feasible.1 Initiate appropriate supportive therapy (fluid and electrolyte management, protein supplementation), anti-infective therapy directed against C. difficile (e.g., metronidazole, vancomycin), and surgical evaluation as clinically indicated.1 12 14 15

Selection and Use of Anti-infectives

To reduce development of drug-resistant bacteria and maintain effectiveness of telavancin and other antibacterials, use only for treatment of infections proven or strongly suspected to be caused by susceptible bacteria.1

When selecting or modifying anti-infective therapy, use results of culture and in vitro susceptibility testing.1 In the absence of such data, consider local epidemiology and susceptibility patterns when selecting anti-infectives for empiric therapy.1

If documented or presumed pathogens include gram-negative or anaerobic bacteria, concomitant use of an anti-infective active against such bacteria may be clinically indicated.1 (See Uses.)

Cardiovascular Effects

Prolongation of the QTc interval reported.1 Caution advised if used with drugs known to prolong QT interval.1

Avoid use in individuals with congenital long QT syndrome, known prolongation of the QTc interval, uncompensated heart failure, or severe left ventricular hypertrophy; such individuals not included in telavancin clinical trials.1

Hematologic Effects

Does not interfere with coagulation and has no effect on platelet aggregation.1 Increased risk of bleeding not observed in clinical trials.1 Evidence of hypercoagulability not observed; healthy adults receiving telavancin have normal levels of D-dimer and fibrin degradation products.1

Interferes with certain tests used to monitor coagulation (i.e., PT, INR, aPTT, activated clotting time, tests based on factor Xa).1 (See Specific Drugs and Laboratory Tests under Interactions.)

Specific Populations

Pregnancy

Category C.1 Pregnancy registry at 888-658-4228.1

In reproduction studies in rats, rabbits, and minipigs, there was evidence that telavancin has the potential to cause limb and skeletal malformations and reduced fetal weight.1

Has not been evaluated in pregnant women, but animal data raise concerns about potential adverse developmental outcomes in humans.1 Avoid use during pregnancy unless potential benefits to the patient outweigh potential risks to the fetus.1 (See Fetal/Neonatal Morbidity under Cautions.)

Lactation

Not known whether telavancin is distributed into milk in humans.1 Use with caution.1

Pediatric Use

Safety and efficacy not established in children or adolescents <18 years of age.1

Geriatric Use

In clinical studies evaluating telavancin for treatment of complicated skin and skin structure infections, the drug appeared to be less effective in adults ≥65 years of age relative to adults <65 years of age.1

No overall differences in frequency of treatment-emergent adverse events compared with younger adults; however, incidence of adverse events indicating renal impairment was higher in geriatric adults than in younger adults.1

Substantially eliminated by kidneys; select dosage with caution since geriatric patients are more likely to have decreased renal function.1

Hepatic Impairment

Pharmacokinetics not altered in adults with moderate hepatic impairment (Child-Pugh class B);1 8 pharmacokinetics not evaluated in those with severe hepatic impairment (Child-Pugh class C).1 Dosage adjustment not needed in adults with mild to moderate hepatic impairment.1 8

Renal Impairment

In clinical studies evaluating telavancin for treatment of complicated skin and skin structure infections, the drug appeared to be less effective in adults with Clcr ≤50 mL/minute relative to those with Clcr >50 mL/minute.1 Consider possible reduced effectiveness when selecting an anti-infective for adults with baseline moderate or severe renal impairment (Clcr ≤50 mL/minute).1

Risk of adverse renal effects may be greater in patients with preexisting renal impairment or risk factors for renal dysfunction.1 (See Nephrotoxicity under Cautions.)

Reduce dosage in adults with Clcr 10–50 mL/minute.1 (See Renal Impairment under Dosage and Administration.)

Hydroxypropyl-β-cyclodextrin (an inactive ingredient in the formulation) may accumulate in individuals with renal impairment.1 If renal toxicity is suspected, consider an alternative anti-infective.1

Common Adverse Effects

GI effects (taste disturbance,1 2 3 nausea,1 2 3 vomiting,1 2 3 constipation2 ), headache,2 3 insomnia,2 3 foamy urine.1 2

Interactions for Vibativ

Drugs Affecting or Metabolized by Hepatic Microsomal Enzymes

Inhibits CYP 3A4/5.1

Specific Drugs and Laboratory Tests

Drug or Test

Interaction

Comments

Aminoglycosides (amikacin, gentamicin)

Gentamicin: In vitro evidence of synergistic antibacterial effects against MRSA6

Amikacin or gentamicin: No in vitro evidence of antagonistic antibacterial effects against telavancin-susceptible staphylococci, streptococci, or enterococci1

Aztreonam

No effect on pharmacokinetics of either drug1 9

No in vitro evidence of antagonistic antibacterial effects against telavancin-susceptible staphylococci, streptococci, or enterococci1

Dosage adjustments not needed1

Carbapenems (imipenem, meropenem)

Meropenem: In vitro evidence of synergistic antibacterial effects against MRSA6

Imipenem or meropenem: No in vitro evidence of antagonistic antibacterial effects against telavancin-susceptible staphylococci, streptococci, or enterococci1

Cephalosporins

Cefepime or ceftriaxone: In vitro evidence of synergistic antibacterial effects against MRSA6

Cefepime or ceftriaxone: No in vitro evidence of antagonistic antibacterial effects against telavancin-susceptible staphylococci, streptococci, or enterococci1

Co-trimoxazole

No in vitro evidence of antagonistic antibacterial effects against telavancin-susceptible staphylococci, streptococci, or enterococci1

Fluoroquinolones

Ciprofloxacin: In vitro evidence of synergistic antibacterial effects against MRSA6

Ciprofloxacin: No in vitro evidence of antagonistic antibacterial effects against telavancin-susceptible staphylococci, streptococci, or enterococci1

Midazolam

No effect on pharmacokinetics of either drug1 7

Penicillins

Piperacillin and tazobactam: No effect on pharmacokinetics of either drug1 9

Oxacillin or piperacillin and tazobactam: No in vitro evidence of antagonistic antibacterial effects against telavancin-susceptible staphylococci, streptococci, or enterococci1

Piperacillin and tazobactam: Dosage adjustments not needed1

Rifampin

In vitro evidence of synergistic antibacterial effects against MRSA6

No in vitro evidence of antagonistic antibacterial effects against telavancin-susceptible staphylococci, streptococci, or enterococci1

Tests, coagulation

Telavancin interferes with PT, INR, aPTT, activated clotting time, and tests based on factor Xa if blood samples are drawn 0–18 hours after a dose of the anti-infective1

Does not affect thrombin time, whole blood (Lee-White) clotting time, ex vivo platelet aggregation, chromogenic factor Xa assay, functional (chromogenic) factor X assay, bleeding time, or tests for D-dimer or fibrin degradation products1

Draw blood samples for PT, INR, aPTT, activated clotting time, and tests based on factor Xa just before a telavancin dose1

Tests, urine protein

Telavancin interferes with urine qualitative dipstick protein assays and quantitative dye methods used to measure urine protein (e.g., pyrogallol red-molybdate);1 does not affect microalbumin assays1

Use microalbumin assays to monitor urinary protein excretion in patients receiving telavancin1

Vibativ Pharmacokinetics

Absorption

Plasma Concentrations

In healthy young adults, pharmacokinetics are linear following single IV doses of 5–12.5 mg/kg or multiple IV doses of 7.5–15 mg/kg given once daily for up to 7 days.1

Steady-state concentrations achieved by day 3 of once-daily dosage.1

Special Populations

AUC increased in patients with renal impairment.1

Distribution

Extent

Concentration in skin blister fluid is 40% of plasma concentrations after administration of 7.5 mg/kg once daily for 3 days.1

Not known whether telavancin is distributed into milk in humans.1

Plasma Protein Binding

90%, primarily albumin.1 Protein binding not affected by renal or hepatic impairment.1

Elimination

Metabolism

Metabolic pathway not elucidated to date.1 Three hydroxylated metabolites identified; the major metabolite is THRX-651540.1

Not metabolized by CYP isoenzymes 1A2, 2C9, 2C19, 2D6, 3A4, 3A5, or 4A11.1

Elimination Route

Approximately 76% of a dose recovered in urine; <1% of dose recovered in feces.1

In adults with end-stage renal disease, approximately 5.9% of a dose is removed by 4 hours of hemodialysis.1 In vitro date indicate telavancin may be removed by continuous venovenous hemofiltration (CVVH).1

Half-life

Approximately 8 hours in adults.1

Special Populations

Pharmacokinetics not altered in geriatric individuals based solely on age.1

Pharmacokinetics altered by decreased renal function.1

No clinically important change in pharmacokinetics in adults with moderate hepatic impairment (Child-Pugh class B).1 8 Not evaluated in adults with severe hepatic impairment (Child-Pugh class C).1

Stability

Storage

Parenteral

Powder for Injection

2–8°C; may be exposed to temperatures up to 25°C.1 Avoid excessive heat.1

Following reconstitution and further dilution, administer within 4 hours when stored at room temperature or within 72 hours when stored at 2–8°C.1

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Parenteral

Solution Compatibility1 HID

Compatible

Dextrose 5% in water

Ringer's injection, lactated

Sodium chloride 0.9%

Drug CompatibilityHID
Y-Site Compatibility

Compatible

Amphotericin B lipid complex

Ampicillin sodium-sulbactam sodium

Azithromycin

Calcium gluconate

Caspofungin acetate

Cefepime HCl

Ceftazidime

Ceftriaxone sodium

Ciprofloxacin

Dexamethasone sodium phosphate

Diltiazem HCl

Dobutamine HCl

Dopamine HCl

Doripenem

Doxycycline hyclate

Ertapenem sodium

Famotidine

Fluconazole

Gentamicin sulfate

Hydrocortisone sodium succinate

Labetalol HCl

Magnesium sulfate

Mannitol

Meropenem

Metoclopramide HCl

Milrinone lactate

Norepinephrine bitartrate

Ondansetron HCl

Pantoprazole sodium

Phenylephrine HCl

Piperacillin sodium-tazobactam sodium

Potassium chloride

Potassium phosphates

Ranitidine HCl

Sodium bicarbonate

Sodium phosphates

Tigecycline

Tobramycin sulfate

Vasopressin

Incompatible

Amphotericin B

Amphotericin B liposomal

Digoxin

Esomeprazole sodium

Furosemide

Levofloxacin

Micafungin sodium

Variable

Colistimethate sodium

Cyclosporine

Heparin sodium

Imipenem-cilastatin sodium

Methylprednisolone sodium succinate

Propofol

Actions

  • Lipoglycopeptide antibacterial.1 2 3 4 5 Synthetic derivative of vancomycin.1 2 3 4 5

  • Usually bactericidal in action.1 Inhibits bacterial cell wall synthesis by inhibiting peptidoglycan synthesis and blocking the transglycosylation step.1 4 Binds to the bacterial membrane and disrupts membrane barrier function.1 4

  • Active against some gram-positive bacteria, including Staphylococcus aureus (including methicillin-resistant S. aureus [MRSA; also known as oxacillin-resistant S. aureus or ORSA]),1 2 3 5 11 Streptococcus pyogenes (group A β-hemolytic streptococci),1 S. agalactiae (group B streptococci),1 S. anginosus group (includes S. anginosus, S. intermedius, S. constellatus),1 and Enterococcus faecalis (vancomycin-susceptible strains only).1 5

  • Some vancomycin-resistant enterococci have reduced susceptibility to telavancin.1 5 Cross-resistance between telavancin and other anti-infectives not reported to date.1

Advice to Patients

  • Telavancin medication guide must be provided to patient each time the drug is dispensed;17 importance of patient reading the medication guide prior to initiating telavancin therapy and each time the prescription is refilled.1

  • Advise patients that antibacterials (including telavancin) should only be used to treat bacterial infections and not used to treat viral infections (e.g., the common cold).1

  • Importance of completing full course of therapy, even if feeling better after a few days.1

  • Advise patients that skipping doses or not completing the full course of therapy may decrease effectiveness and increase the likelihood that bacteria will develop resistance and will not be treatable with telavancin or other antibacterials in the future.1

  • Advise patients that diarrhea is a common problem caused by anti-infectives and usually ends when the drug is discontinued.1 Importance of contacting a clinician if watery and bloody stools (with or without stomach cramps and fever) occur during or as late as 2 months or longer after the last dose.1

  • Advise patients about the common adverse effects reported with telavancin (e.g., taste disturbance, nausea, vomiting, headache, foamy urine) and importance of informing a clinician if any unusual symptom develops or if any known symptom persists or worsens.1

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, and any concomitant illnesses.1

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.1 Advise women of childbearing potential about potential risk of fetal harm if telavancin is used during pregnancy.1 (See Pregnancy under Cautions.)

  • Importance of excluding pregnancy with a serum pregnancy test before starting telavancin.1 Advise women of childbearing potential to use effective contraception to prevent pregnancy during telavancin therapy and to notify a clinician if pregnancy occurs during telavancin therapy.1 (See Pregnancy under Cautions.)

  • Importance of informing patients of other important precautionary information.1 (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Telavancin Hydrochloride

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

For injection, for IV infusion

250 mg (of telavancin)

Vibativ

Theravance

750 mg (of telavancin)

Vibativ

Theravance

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions January 7, 2014. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

References

1. Theravance. Vibativ (telavancin) for injection prescribing information. South San Francisco, CA; 2012 Jan..

2. Stryjewski ME, Graham DR, Wilson SE et al. Telavancin versus vancomycin for the treatment of complicated skin and skin-structure infections caused by gram-positive organisms. Clin Infect Dis. 2008; 46:1683-93. [PubMed 18444791]

3. Stryjewski ME, Chu VH, O'Riordan WD et al. Telavancin versus standard therapy for treatment of complicated skin and skin structure infections caused by gram-positive bacteria: FAST 2 study. Antimicrob Agents Chemother. 2006; 50:862-7. [PubMed 16495243]

4. Shaw JP, Seroogy J, Kaniga K et al. Pharmacokinetics, serum inhibitory and bactericidal activity, and safety of telavancin in healthy subjects. Antimicrob Agents Chemother. 2005; 49:195-201. [PubMed 15616296]

5. Dunbar LM, Tang DM, Manausa RM. A review of telavancin in the treatment of complicated skin and skin structure infections (cSSSI). Ther Clin Risk Manag. 2008; 4:235-44. [PubMed 18728713]

6. Lin G, Pankuch GA, Ednie LM et al. Antistaphylococcal activity of telavancin tested alone and in combination by time-kill assay. Antimicrob Agents Chemother. 2010; :.

7. Wong SL, Goldberg MR, Ballow CH et al. Effect of Telavancin on the pharmacokinetics of the cytochrome P450 3A probe substrate midazolam: a randomized, double-blind, crossover study in healthy subjects. Pharmacotherapy. 2010; 30:136-43. [PubMed 20099988]

8. Goldberg MR, Wong SL, Shaw JP et al. Lack of effect of moderate hepatic impairment on the pharmacokinetics of telavancin. Pharmacotherapy. 2010; 30:35-42. [PubMed 20030471]

9. Wong SL, Sörgel F, Kinzig M et al. Lack of pharmacokinetic drug interactions following concomitant administration of telavancin with aztreonam or piperacillin/tazobactam in healthy participants. J Clin Pharmacol. 2009; 49:816-23. [PubMed 19443680]

11. Kosowska-Shick K, Clark C, Pankuch GA et al. Activity of telavancin against staphylococci and enterococci determined by MIC and resistance selection studies. Antimicrob Agents Chemother. 2009; 53:4217-24. [PubMed 19620338]

12. Cohen SH, Gerding DN, Johnson S et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Rpidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol. 2010; 31:431-55. [PubMed 20307191]

14. Fekety R for the American College of Gastroenterology Practice Parameters Committee. Guidelines for the diagnosis and management of Clostridium difficile-associated diarrhea and colitis. Am J Gastroenterol. 1997; 92:739-50. [IDIS 386628] [PubMed 9149180]

15. American Society of Health-System Pharmacists Commission on Therapeutics. ASHP therapeutic position statement on the preferential use of metronidazole for the treatment of Clostridium difficile-associated disease. Am J Health-Syst Pharm. 1998; 55:1407-11. [IDIS 407213] [PubMed 9659970]

17. NDA 22-110 Vibativ (telavancin) risk evaluation and mitigation strategy (REMS). From FDA website.

HID. Trissel LA. Handbook on injectable drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013. Electronic update.

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