Telithromycin is an antibiotic from the macrolide group. There is no evidence that it is more effective than other macrolides, whatever the bacteria in question.

Pharmacovigilance reports obtained by Prescrire from the European Medicines Agency (EMA) detail nearly 3350 severe adverse effects associated with telithromycin between July 2010 and July 2011, including 22 deaths.

From the commercialisation of telithromycin in the early 2000s to 2011, there is evidence of 822 hepatic adverse effects in 653 patients; 425 cardiac adverse effects, sometimes fatal, were reported in 377 patients; plus 75 reports of neuromuscular damage and 261 of muscular damage.

Telithromycin causes the same adverse effects as the other macrolides, but with several particularities: visual disorders, taste and smell disorders, severe hepatic damage, severe neuromuscular disorders. Cardiac conduction disorders associated with habitual oral doses are a specific cause for concern.

The spectrum of adverse effects also includes renal failure, neuropsychological disorders, severe skin reactions, bleeding disorders and pancreatitis.

Given these findings, it is better to rule out telithromycin, which exposes patients to disproportionately severe adverse effects. When a macrolide-group antibiotic is required, it is advisable to prescribe another macrolide such as spiramycin or azithromycin, as appropriate, since they are associated with fewer severe adverse effects.

©Prescrire 1 November 2014

"Telithromycin: review of adverse effects" Prescrire Int 2014; 23 (154): 264-266. (Pdf, subscribers only).