Quinupristin/dalfopristin
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Uses
- Antibiotic: treatment of vancomycin-resistant Enterococcus faecium, as well as nosocomial pneumonias and infections secondary to IV catheters (1)
Administration
- Dosage Forms: 500mg vials, diluted into 250 mL and given over 60 mins
- Routes of Administration: IV
- Common Trade Names: Synercid
Adult Dosing
- VRE: 7.5mg/kg IV q8 hrs for minimum 7 days
- skin infections: 7.5mg/kg IV q12 hrs for minimum 7 days
Pediatric Dosing
- safety and efficacy has not been studied in children
Special Populations
- Pregnancy Rating: B
- Lactation risk: unknown whether secreted in human breast milk. Caution should be exercised when administering to nursing mothers. (2)
Renal Dosing
- no adjustments for renal impairment
Hepatic Dosing
- dosage may need to be adjusted in patients with cirrhosis, however specific dose modification is not known at this time (2)
Contraindications
- Allergy to class/drug
Adverse Reactions
Serious
Common
- pain and inflammation at infusion site
- arthralgias
- nausea/vomiting/diarrhea
- rash
- headache
- pruritus
Pharmacology
- Half-life: Quinupristin: 3 hrs; Dalfopristin: 1 hr
- Metabolism: significantly interacts with the CYP 3A4 system.
- Excretion:
Antibiotic Sensitivities[1]
Key
- S susceptible/sensitive (usually)
- I intermediate (variably susceptible/resistant)
- R resistant (or not effective clinically)
- S+ synergistic with cell wall antibiotics
- U sensitive for UTI only (non systemic infection)
- X1 no data
- X2 active in vitro, but not used clinically
- X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
- X4 active in vitro, but not clinically effective for strep pneumonia
References
- 1. JP Manzanella. "Quinupristin-Dalfopristin: A New Antibiotic for Severe Gram-Positive Infections." American Family Physician. 2001 Dec 1;64(11):1863-1867.
- 2. U.S. Food and Drug Administration. Synercid I.V. November 2007. Retrieved from http://www.accessdata.fda.gov/drugsatfda_docs/label/2008/050748s008,050747s008lbl.pdf
- ↑ Sanford Guide to Antimicrobial Therapy 2014