临床药师参与治疗2 例多重耐药肺炎链球菌脑膜炎患儿实践体会

目的：探讨临床药师在多重耐药肺炎链球菌脑膜炎患儿抗感染治疗中的作用。方法：临床药师参与2例多重耐药肺炎链球菌脑膜炎患儿的治疗过程。2例患儿根据药敏结果选择万古霉素作为主要抗感染药物，感染指标未下降，病情恶化。临床药师分析了万古霉素治疗效果不佳的原因，建议医生换用利奈唑胺，并对利奈唑胺在儿童细菌性脑膜炎中的应用进行了分析。结果：2例患儿在用利奈唑胺治疗2周后，感染得到控制，好转出院。结论：临床药师参与抗感染方案制定，可以为医生提供参考，最终使患者获益。     

长疗程利奈唑胺致全血细胞减少1例临床分析

<正>利奈唑胺(linezolid)为恶唑烷酮类抗菌药物,是继磺胺类和喹诺酮类后上市的又一类全新合成抗菌药物,该药主要用于控制耐万古霉素革兰阳性球菌所引起的感染。最近研究显示,利奈唑胺具有良好的抗结核分枝杆菌(mycobacterium tuberculosis,MTB)作用,对耐药菌株也显示了强大的抗菌活性。近年来随着利奈唑胺在临床上的应用,其不良反应的报道逐渐增多,利奈唑胺致血小板减少和白细胞减少的不良反应均已有报道,但全血细胞减少较为少见。我院长疗程应用利奈唑胺治疗1例难治性结核性脑膜炎出现全血细胞可逆性减少,现将     

耐甲氧西林金黄色葡萄球菌耐药表型分型与耐药基因检测分析研究

目的分析研究耐甲氧西林金黄色葡萄球菌(methicillin-resistant staphylococcus aureus,MRSA)的耐药表型及耐药基因,探索治疗MRSA感染的有效手段。方法对临床分离的耐甲氧西林金黄色葡萄球菌株,依据美国临床实验室标准化研究所(CLSI)标准操作规程进行万古霉素、利奈唑胺和苯唑西林等药物的药物敏感性试验和耐药基因检测,分别采用微量肉汤稀释法和多重聚合酶链反应(PCR)扩增法。结果 MRSA耐药表型分为Ⅰ~Ⅶ型,MRSA对抗生素产生多重耐药,万古霉素、利奈唑胺、氯霉素、复方新诺明、利福平耐药率分别为0、7.0%、40.8%、47.9%、60.6%,β-内酰胺类药物耐药率高达100%;实验菌株mecA、ermA、ermC、tetK、tetM、ratA基因检出率分别为98.6%、60.6%、18.3%、100%、7.0%和0。结论 MRSA对万古霉素、利奈唑胺敏感,其他药物呈多重耐药,需加强MRSA对万古霉素、利奈唑胺、氯霉素、复方磺胺、利福平等常用药物最小抑菌浓度(MIC)监测和临床报告,关注万古霉素对MRSA治疗不佳患者。     

中枢神经系统耐甲氧西林金黄色葡萄球菌感染治疗方案选择

万古霉素、替考拉宁、利奈唑胺是临床常用的治疗耐甲氧西林金黄色葡萄球菌(MRSA)感染的抗菌药物,由于其不同的药代动力学及不良反应特点导致其在临床应用中的侧重点各有不同。由于血脑屏障的存在,中枢神经系统感染尤其是MRSA感染的治疗尤为困难。该研究从药代动力学方面分析了替考拉宁在中枢神经系统感染中的应用以及从药物疗效、药物经济学及药物不良反应三个方面比较了万古霉素脑室给药和利奈唑胺外周静脉给药对于中枢神经系统MRSA感染的优劣,为临床颅内感染治疗方案的选择提供借鉴意义。     

利奈唑胺治疗老年COPD并多重耐药革兰阳性球菌感染的疗效分析

目的了解利奈唑胺治疗老年COPD并多重耐药革兰阳性球菌感染的临床疗效和安全性。方法回顾性分析2008年1月至2011年11月我院26例老年COPD患者使用利奈唑胺治疗老年COPD伴多重耐药革兰阳性球菌感染的临床资料。结果利奈唑胺治疗老年COPD患者并多重耐药革兰阳性球菌感染临床有效率89.3%,细菌清除率100%,不良反应发生率11.5%。结论利奈唑胺治疗老年COPD并多重耐药革兰阳性球菌感染既有效又安全。     

利奈唑胺治疗多重耐药革兰阳性细菌性心内膜炎的研究进展

利奈唑胺是新型噁唑烷酮类抗生素,可口服,也可静脉应用.其口服生物利用度为100%,组织穿透能力强,即使在心脏瓣膜或赘生物上其局部浓度亦高.利奈唑胺与其他抗生素无交叉耐药性.虽然体外试验表明利奈唑胺主要是抑菌性的,但其对多重耐药革兰阳性菌,如凝血酶阴性葡萄球菌(CNS)、耐甲氧西林金葡菌(MRSA)、耐万古霉素肠球菌(VRE)等均有抗菌活性.已经证实,利奈唑胺能有效治疗动物模型实验性IE.利奈唑胺治疗人类IE时,既有成功也有失败的报道.一般来说,利奈唑胺耐受性好.长期治疗偶可引起可逆性骨髓抑制,如贫血及血小板减少.最近美国心脏学会(AHA)公布的指南建议,虽然利奈唑胺不作为IE治疗的一线药物,但对多重耐药革兰阳性菌株引起的IE,尤其对"标准疗法"有禁忌证或治疗失败,或不能耐受糖肽类抗生素者来说,还是一个重要的治疗选择.     

利奈唑胺治疗新生儿感染性疾病的研究进展

目的:了解利奈唑胺治疗新生儿感染性疾病的研究进展。方法:查阅近年来国内外相关文献,就利奈唑胺的作用机制、药动学特征和在新生儿感染性疾病中的应用的研究进行归纳和总结。结果和结论:利奈唑胺未被完全批准用于新生儿,但多项研究显示出利奈唑胺治疗新生儿耐药革兰氏阳性菌感染安全、有效,尤其是对新生儿败血症的治疗,利奈唑胺与万古霉素疗效相当。在新生儿中,利奈唑胺的给药可根据疾病、出生时体质量、胎龄和日龄等因素选择给药方案。新生儿中利奈唑胺的不良反应发生率较万古霉素低,但由于会引起骨髓抑制,用药期间需密切监测全血细胞计数。我国尚需大样本的研究用于评估利奈唑胺在新生儿感染性疾病治疗中的疗效和安全性。     

万古霉素和利奈唑胺治疗革兰阳性球菌感染给药方案优化

摘要： 目的 评价并优化万古霉素和利奈唑胺治疗不同革兰阳性球菌感染的给药方案。方法 根据抗菌药物的药动学/药效学理论, 将万古霉素和利奈唑胺的药代动力学参数, 结合这 2 种药物对表皮葡萄球菌、 金黄色葡萄球菌、 粪肠球菌和屎肠球菌的体外药效学数据进行蒙特卡洛模拟, 通过比较 2 种药物不同给药方案对 4 种革兰阳性球菌的累积反应分数 （CFR） 来评价并优化给药方案。结果 当患者感染表皮葡萄球菌时, 推荐使用万古霉素 3 500 mg/d 的给药方案; 当患者感染金黄色葡萄球菌时, 推荐使用万古霉素 2 500 mg/d 的方案; 当患者感染粪肠球菌时, 推荐使用万古霉素 3 000 mg/d 或利奈唑胺 400 mg/次, 每日 2 次的方案; 当患者感染屎肠球菌时, 推荐使用万古霉素 2 500 mg/d 或利奈唑胺 400 mg/次, 每日 2 次的方案。结论 在应用万古霉素和利奈唑胺治疗革兰阳性球菌感染时,应根据感染菌种类选择不同的给药方案。     

利奈唑胺和万古霉素对重症监护治疗病房革兰阳性球菌感染患者治疗效果的Meta分析

目的:比较、评价利奈唑胺和万古霉素治疗重症监护治疗病房(intensive care unit,ICU)革兰阳性球菌感染患者的疗效及安全性。方法:采用Meta分析的方法,用计算机检索Pub Med、Cochrane Library、CNKI和万方数据库,评价筛选文献,纳入利奈唑胺和万古霉素的随机对照试验(RCT),并采用Rev Man 5.2进行Meta分析。结果:6个随机对照试验,共纳入革兰阳性球菌感染的ICU患者444名,其中利奈唑胺组218名,万古霉素组226名。Meta分析显示,临床治疗有效率,利奈唑胺优于万古霉素[OR=3.07,95%CI(1.76,5.34),P<0.01],细菌清除率上,利奈唑胺高于万古霉素[OR=3.83,95%CI(1.81,8.12),P=0.000 5];微生物学治愈率和不良反应发生率,利奈唑胺与万古霉素两组间差异均无统计学意义。结论:在治疗ICU重症患者革兰氏阳性球菌感染中,利奈唑胺在临床有效率和细菌清除率方面,明显优于万古霉素,而在微生物学治愈率和不良反应发生率上利奈唑胺则和万古霉素相当,但仍需要更大样本量、更加严格设计的随机对照试验进一步验证。     

利奈唑胺注射液致严重眩晕

利奈唑胺是第一个应用于临床新型嗯唑烷酮类抗菌药,主要用于耐药的革兰阳性球菌所致感染,包括耐甲氧西林金黄色葡萄球菌引起的疑似或确诊院内获得性肺炎、社区获得性肺炎、复杂性皮肤或皮肤软组织感染以及耐万古霉素肠球菌等的感染。由于利奈唑胺抗菌机制特殊,与其他抗菌药物之间无交叉耐药性,并且老年患者、肝肾功能异常患者使用时无需调整剂量等特点,     

Linezolid: a review of its use in the management of serious gram-positive infections

Linezolid is the first of a new class of antibacterial drugs, the oxazolidinones. It has inhibitory activity against a broad range of gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), glycopeptide-intermediate S. aureus (GISA), vancomycin-resistant enterococci (VRE) and penicillin-resistant Streptococcus pneumoniae. The drug also shows activity against certain anaerobes, including Clostridium perfringens, C. difficile, Peptostreptococcus spp. and Bacteroidesfragilis. In controlled phase III studies, linezolid was as effective as vancomycin in the treatment of patients with infections caused by methicillin-resistant staphylococci and also demonstrated efficacy against infections caused by VRE. Further phase III studies have demonstrated that linezolid is an effective treatment for patients with nosocomial pneumonia, for hospitalised patients with community-acquired pneumonia, and for patients with complicated skin or soft tissue infections (SSTIs). In these studies, linezolid was as effective as established treatments, including third-generation cephalosporins in patients with pneumonia, and oxacillin in patients with complicated SSTIs. Oral linezolid 400 or 600mg twice daily was as effective as clarithromycin 250mg twice daily or cefpodoxime proxetil 200mg twice daily in the treatment of patients with uncomplicated SSTIs or community-acquired pneumonia. Linezolid is a generally well tolerated drug. The most frequently reported adverse events in linezolid recipients were diarrhoea, headache, nausea and vomiting. Thrombocytopenia was also documented in a small proportion (about 2%) of patients treated with the drug. CONCLUSIONS: Linezolid has good activity against gram-positive bacteria, particularly multidrug resistant strains of S. aureus (including GISA), Enterococcus faecium and E. faecalis (including VRE). In controlled clinical trials, linezolid was as effective as vancomycin in eradicating infections caused by methicillin-resistant Staphylococcus spp. and has demonstrated efficacy against infections caused by VRE. As the level of resistance to vancomycin increases among S. aureus and enterococci, linezolid is poised to play an important role in the management of serious gram-positive infections.     

万古霉素脑室内注射治疗成人中枢神经系统感染的研究进展

中枢神经系统(CNS)周围的屏障以及多重耐药菌的出现对有效治疗CNS感染提出了治疗挑战。万古霉素是一种糖肽类抗生素，用于治疗和预防由革兰阳性菌引起的各种细菌感染，包括耐甲氧西林金黄色葡萄球菌(MRSA)。它也用于肠球菌、链球菌和甲氧西林敏感的金黄色葡萄球菌(MSSA)等引起的感染。万古霉素被推荐作为颅内感染的一线治疗药物。然而，通过静脉(IV)输注给药时，万古霉素在脑脊液(CSF)中的渗透是有限的。万古霉素通过脑室内(IVT)给药可绕过血脑屏障直接到达目标部位，实现高浓度以获得更好的杀菌作用。万古霉素IVT给药的适应症主要包括对IV抗生素反应较差的脑膜炎、脑室炎、颅内装置感染和脑脓肿。本文综述了成人万古霉素IVT给药的研究现状，旨在为临床实践提供参考。根据现有证据，使用万古霉素IVT给药治疗CNS感染是安全有效的。万古霉素IVT给药的最佳给药方案需要考虑到不同患者CNS的病理生理学特点并根据具体情况进行临床判断。     

Oritavancin and tigecycline: investigational antimicrobials for multidrug-resistant bacteria

The advent of multidrug-resistant gram-positive aerobes such as Staphylococcus aureus, Streptococcus pneumoniae, and the enterococci, which are resistant to beta-lactams, vancomycin, and a host of other commonly used antimicrobials, has complicated our approach to antibiotic therapy. Despite marketing of the first oxazolidinone, linezolid, and the streptogramin combination, quinupristin-dalfopristin, an urgent need exists for more agents to combat these pathogens. Two such agents, the glycopeptide oritavancin (LY333328) and the glycylcycline tigecycline (GAR-936), are in phase III clinical trials. These agents, which require parenteral administration, exhibit substantial in vitro activity against a variety of gram-positive aerobes and anaerobes, including the multidrug-resistant organisms listed previously. Only tigecycline demonstrates useful activity against gram-negative organisms. Combination therapy of these agents with ampicillin or aminoglycosides frequently leads to synergistic in vitro activity against multidrug-resistant staphylococci and streptococci. These agents are also active in a variety of animal models of systemic and localized infections. Few published efficacy and tolerability data are available in humans. If controlled clinical trial data verify these agents' efficacy and tolerability, both drugs should become welcome additions to the available antimicrobials. However, restricting their use to the treatment of infections caused by bacteria resistant to other antimicrobials, especially multidrug-resistant staphylococci and streptococci, may prolong their clinical utility by retarding the development of resistance. Careful surveillance of bacterial sensitivity to these agents should be undertaken to assist clinicians in the decision whether or not to use these agents empirically to treat infections caused by suspected multidrug-resistant gram-positive pathogens.     

成人胸腔感染病原菌分布及耐药性分析

目的 分析胸腔感染的病原菌分布及耐药情况.方法 回顾性分析2015年1月至2020年2月于我院住院的胸腔积液患者的临床资料和病原菌培养结果.结果 纳入120例胸腔积液病原菌培养阳性的患者,共分离出病原菌143株,包括革兰氏阳性菌62株(43.36％),革兰氏阴性菌71株(49.65％),真菌10株(6.99％).主要革...     

Linezolid: a pharmacoeconomic review of its use in serious Gram-positive infections

Linezolid (Zyvox), the first available oxazolidinone antibacterial agent, has good activity against Gram-positive pathogens, including multidrug-resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecium. Randomised multicentre trials in patients with various types of serious Gram-positive infections showed that clinical cure rates with linezolid were similar to those with vancomycin or teicoplanin. In some subgroup analyses, which must be interpreted with a degree of caution, clinical advantages were noted for linezolid (e.g. versus vancomycin in confirmed MRSA nosocomial pneumonia and MRSA-complicated skin and soft tissue infections). Although generally well tolerated, gastrointestinal adverse effects are relatively common with linezolid and it has been associated with thrombocytopenia and myelosuppression. The oral bioavailability of linezolid is approximately 100%, thus allowing sequential intravenous-to-oral administration without changing the drug or dosage regimen. Healthcare resource use data from various countries indicate that this practical advantage translates into at least a trend towards reduced length of hospital stay compared with vancomycin, which may offset its several-fold higher acquisition cost. Modelled analyses from the US, despite some limitations, indicate that, compared with vancomycin, linezolid is associated with lower total hospitalisation costs for the treatment of patients with cellulitis and has a favourable incremental cost-effectiveness ratio of approximately US30,000 dollars per QALY gained (2001 value) for patients with ventilator-associated pneumonia. Broadly similar results have also been reported in modelled analyses from other countries. In conclusion, for patients with serious Gram-positive infections, including those caused by suspected or proven multidrug-resistant pathogens such as MRSA, linezolid is an effective and generally well tolerated therapeutic option. Linezolid is currently the only antibacterial agent with good activity against MRSA that can be administered orally (as well as intravenously). It may be particularly useful as an alternative to vancomycin in patients who have impaired renal function, poor or no intravenous access, require outpatient therapy, or who have been unable to tolerate glycopeptides. Healthcare resource use studies and pharmacoeconomic analyses generally support the use of linezolid in some subgroups of patients, although results should be interpreted with due consideration of the study limitations.     

Benefit-risk assessment of linezolid for serious gram-positive bacterial infections

Linezolid is an oxazolidinone, a new class of antibacterial with a unique mechanism of action, namely inhibition of the formation of a functional 70S initiation complex in the 50S bacterial ribosomal subunit. Linezolid is highly active against multidrug-resistant Gram-positive cocci, including meticillin-resistant Staphylococcus aureus (MRSA), vancomycin-intermediate and vancomycin-resistant S. aureus, and vancomycin-resistant enterococci; its spectrum of activity also includes some anaerobic bacteria.Linezolid has been studied in several randomized controlled trials for the treatment of patients with community-acquired and nosocomial pneumonia, skin and soft tissue infections (SSTIs), urinary tract infections and bacteraemia. The available evidence suggests that linezolid is at least as effective as vancomycin for patients with nosocomial pneumonia, and there are some retrospective analyses supporting its superiority in comparison with vancomycin for MRSA nosocomial pneumonia, including ventilator-associated pneumonia. Linezolid is more effective than glycopeptides, macrolides and beta-lactams for SSTIs. The limited available data for the treatment of patients with bacteraemia suggest that it may be a better treatment option than vancomycin and beta-lactams for these patients, but questions have arisen regarding patients with catheter-related bacteraemias.Compared with other antibacterials, linezolid is associated with a greater frequency of adverse events, mainly nausea, vomiting, diarrhoea and headaches. Thrombocytopenia also occurs more frequently in patients taking linezolid but there is no increased frequency of anaemia. Other adverse events potentially related to linezolid therapy include fungal infections (moniliasis), hypertension and serotonin-like syndrome, tongue discolouration and taste alterations, dizziness, insomnia, rash and Clostridium difficile-related diarrhoea. The majority of adverse events develop after prolonged administration (i.e. >2 weeks) and subside shortly after discontinuation of linezolid. Peripheral or optic neuropathy, another possible adverse effect, is associated with an even longer duration of treatment (3-6 months).In conclusion, linezolid is an important treatment option for the treatment of patients with multidrug-resistant, Gram-positive bacterial infections. However, in order to reduce the possibility of development of resistance and preserve its activity, the use of linezolid should be restricted to treatment of patients with infections associated with high morbidity and mortality, particularly those caused by multidrug-resistant bacteria.     

利奈唑胺对临床分离阳性球菌的体外敏感性分析

目的:对比利奈唑胺与万古霉素及其他几种常用抗菌药物对临床分离阳性球菌的体外抗菌活性。方法:按照NCCLS(CLSI)2007纸片扩散法操作标准测定利奈唑胺与其他几种常用抗菌药物的体外抗菌活性。结果:本院分离的耐甲氧西林金黄色葡萄球菌(MRSA)比例较高(79.1%),利奈唑胺、万古霉素、替考拉宁的敏感率均达到100%。耐甲氧西林凝固酶阴性葡萄球菌(MRC-NS)的比例较MRSA高(88.9%),利奈唑胺与万古霉素、替考拉宁活性相当,敏感率均为100%。利奈唑胺对粪肠球菌的活性与万古霉素、替考拉宁相当,对屎肠球菌的活性优于万古霉素和替考拉宁(100%,80.4%,78.1%),对青霉素耐药的肺炎链球菌(PRSP)也表现了优越的抗菌活性。结论:对于MRSA、MRCNS、PRSP、粪肠球菌,利奈唑胺与万古霉素、替考拉宁的活性相当,均为100%的敏感率;对屎肠球菌的抗菌活性优于万古霉素和替考拉宁,是治疗多药耐药阳性球菌感染的新型药物。     

Comparative in vitro activity of telavancin, vancomycin and linezolid against heterogeneously vancomycin-intermediate Staphylococcus aureus (hVISA)

Selective pressure from glycopeptide use has led to non-susceptible strains of Staphylococcus aureus, including heterogeneously vancomycin-intermediate S. aureus (hVISA). Treatment of hVISA infections with vancomycin has been associated with treatment failure, therefore new treatments are required. The objective of this study was to evaluate the activity of telavancin, vancomycin and linezolid against hVISA clinical strains. Twenty-five hVISA isolates were evaluated for minimum inhibitory concentrations (MICs) by microdilution and for bactericidal activity by time-kill analysis [starting inoculum ca. 10(6)colony-forming units (CFU)/mL and ca. 10(8)CFU/mL] against telavancin, vancomycin and linezolid. MICs for 50% and 90% of the organisms (MIC(50) and MIC(90) values, respectively) were, respectively, 0.5mg/L and 1mg/L for telavancin and 2mg/L and 2mg/L for both vancomycin and linezolid. In time-kill studies, telavancin was bactericidal against all strains at plasma peak and trough concentrations and at low and high inocula. At low inoculum, the time to bactericidal activity (defined as 99.9% kill from initial inoculum) (T(99.9)) for telavancin was 5.6 ± 3.2 h at peak concentration and 12.3 ± 5.2 h at trough concentration. This was superior to vancomycin (P<0.001), which had a T(99.9) of 18.8 ± 2.1 h at peak concentration and 19.1 ± 2.2 h at trough concentration. At high inoculum, telavancin had a T(99.9) of 16.3 ± 3.2 h at peak concentration and 21.4 ± 2.5 h at trough concentration, whilst vancomycin did not consistently achieve bactericidal activity. Linezolid was not bactericidal against any strain at either concentration or inoculum. In conclusion, the killing activity of telavancin against hVISA was found to be superior to vancomycin and linezolid.     

Linezolid - the first oxazolidinone in the treatment of nosocomial MRSA pneumonia

The incidence of nosocomial pneumonia involving multi-drug resistant Staphylococcus aureus strains (MRSA) in particular is on the rise worldwide. For years, vancomycin has been used as the drug of choice in the treatment of MRSA infections and was recommended as such by clinical guidelines. Inadequate drug levels in pulmonary compartments due to large molecular size may be the cause of the comparatively low survival rates of patients with MRSA pneumonia treated with vancomycin, despite in vitro susceptibility of the bacterial isolates. Several trials demonstrated the clinical effectiveness of the novel oxazolidinone linezolid in nosocomial MRSA pneumonia. Linezolid achieves higher pulmonary concentrations than vancomycin which may be the cause of superior survival rates observed with linezolid in nosocomial MRSA pneumonia. Staphylococcus aureus strains with reduced susceptibility to vancomycin (VISA) are encountered with increasing frequency and may contribute to clinical failures of vancomycin. To date, linezolid-resistance appears to be rare and predominantly affects Enterococci, while very few linezolid-resistant S. aureus isolates were reported. Reduced susceptibility to linezolid is caused by point mutations in the 23S ribosomal RNA genes, which may be selected for by long-term therapy. The future development of linezolid resistance is hard to predict since the drug has been in use only for a limited period of time. This article describes the drug profile, patents and current data on the clinical efficacy of linezolid and reviews its role in treatment of MRSA pneumonia.     

Telavancin: an antimicrobial with a multifunctional mechanism of action for the treatment of serious gram-positive infections

Telavancin is a once-daily lipoglycopeptide antibiotic structurally derived from vancomycin. It has broad-spectrum activity against gram-positive bacteria, including strains with reduced susceptibility to vancomycin. Telavancin's multifunctional mechanism of action, including inhibition of peptidoglycan synthesis and disruption of membrane potential, account for this enhanced activity as well as rapid bactericidal properties. In vitro activity has been demonstrated against a wide range of gram-positive pathogens such as multidrug-resistant Streptococcus pneumoniae, as well as methicillin-resistant, glycopeptide-intermediate, and vancomycin-resistant Staphylococcus aureus. The agent also displays activity against many gram-positive anaerobic organisms. Predictable linear pharmacokinetics have been demonstrated over a wide range of doses, with the most common adverse effects being taste disturbance and nausea. Clinical experience with telavancin in phase II and III studies for complicated skin and skin structure infections has shown it to have similar efficacy and tolerability compared with vancomycin and antistaphylococcal penicillins, and recently telavancin received an approvable letter from the United States Food and Drug Administration for this indication. Telavancin appears to be a promising agent for the treatment of serious infections caused by gram-positive pathogens, including drug-resistant pathogens. Further clinical experience will clarify its role in therapy.