JUNE 1st, 2006 Pharmaceutical Formulary Issue
Telithromycin Controversy and Availability-Risk With Any Drug
My experience with telithromycin has been a unique and academically stimulating medical endeavor. Patients were returning to my arena with recurrent infections and treatment failures with the standard sulfa and penicillin/clav acid approaches to sinusitis and chronic bronchitis exacerbations. Although this is not a clinical study under research guidelines, my clinical suspicion led me to prescribe telithromycin. Over the last approximately 20 months of my experience with this ketolide antibiotic, only 1 or 2 patients were given a second course of antibiotics. Patient volumes are in the hundreds now with regard to this issue. This is in direct comparison to repeating antibiotics with the sulfa, penicillin, cephalosporins, and flouroquinolone lines – especially in the sinusitis group. Patients tolerate this medicine well with few complaints of side effects and few patients have called to be switched to a different antibiotic. Most of the time, just verifying food intake with the antibiotic calms the issue. With the recent trend of antibiotic resistance, including increasing macrolide and flouroquinolone resistance, it would make sense to free up the use of this ketolide. As of the last time I read literature on this ketolide, there was no resistance to it in Europe and none in the US either. We know that the flouroquinolone use has been abused, what I believe to the point of causing even increased and changing C. difficile resistance. Telithromycin is recommended as a possible first line in the Sanford Guide. The article in AIM, March, 2006 discussed idiosyncratic hepatic reactions using this ketolide. That article appears biased from the title through the article, minimizing alcohol use, pathology, and that risk would appear similar to other antibiotics in general. The Editorial is much more balanced in its realistic view of this study. All cases treated by same team, similar locale. Other studies showed less side effects compared to other drugs in the same categories. Academic fraud? Error? Was the case management peer-reviewed for others possibilities? It appears that no one really read the study. State and federal funding for this ketolide should be allowed for acute infections. Insurance funding should make it easier to afford. To me, relaxing the financial noose would be cost efficient by saving repeat visits to ERs, practitioners, clinics, and possibly hospitalizations. This direct effect would be due to solo treatment – not dual treatment, not repeat treatment, not treatment failures leading to increased morbidity. Respectfully submitted as personal opinion only.