Telavancin has been approved by the European Medicines Agency (EMA) only for hospital-acquired pneumonia (HAP) known or suspected to be caused by methicillin-resistant Staphylococcus aureus (MRSA). It is a glycopeptide antibiotic derivative of vancomycin and like vancomycin only covers gram-positive bacteria. Its mechanism of action includes inhibition of cell wall biosynthesis similar to vancomycin. In addition, it binds to bacterial cell membranes, causing depolarisation of membrane potential and causing an increase in cell membrane permeability. Does that actually translate into a stronger antibiotic? It does not appear so at this time. Telavancin is a bit of a pharmacotherapy nightmare. The reason why it is a nightmare is because it actually works and it has not been shown to be inferior to vancomycin. Why is that a problem? It is a problem because it becomes difficult to say no to providers who want …