Quinupristin/Dalfopristin

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Quinupristin/Dalfopristin
Brands

DEA Class; Rx

Common Brand Names; Synercid

  • Streptogramins

Streptogramin antibiotics isolated from Streptomyces pristinaespiralis. They act synergistically against susceptible bacteria when administered together. The combination has up to 16 times the activity of each agent alone. Used for vancomycin-resistant Enterococcus faecium bacteremia and for complicated skin and skin-structure infections due to Staphylococcus aureus.

Indicated for the treatment of complicated skin and skin structure infections.

Indicated for complicated skin and skin structure infections caused by Staphylococcus aureus (methicillin susceptible) or Streptococcus pyogenes

Bacteremia (Off-label)

  • IDSA guidelines recommend for methicillin-resistant S aureus

Intravascular Catheter-associated Bacteremia (Off-label)

  • IDSA guidelines recommend for methicillin-resistant coagulase negative staphylococci or ampicilin0 and vancomycin-resistant E Faecium)

Hypersensitivity to drug, or other streptogramins (eg, pristinamycin, virginiamycin)

  • Local pain (40-44%)
  • Inflammation at infusion site (38-42%)
  • Hyperbilirubinemia (3-35%)
  • Local edema (17-18%)
  • Infusion site reaction (12-13%)
  • Arthralgia (<1-8%)
  • Nausea (3-5%)
  • Myalgia (<1-5%)
  • Vomiting (3% to 4%)
  • Anemia (3%)
  • Diarrhea (3%)
  • incr LDH (3%)
  • Rash (3%)
  • Pain (2-3%)
  • Headache (2%)
  • Increased CPK (2%)
  • Increased GGT (2%)
  • Pruritus (2%)
  • Thrombophlebitis (2%)
  • Hyperglycemia (1%)

Not active against E. faecalis

Caution in hepatic impairment

May cause arthralgias/myalgias, hyperbilirubinemia and phlebitis

Prolonged use may result in fungal or bacterial superinfection

Inhibits metabolism of drugs metabolized by CYP3A4

May prolong QTc when administered concurrently with cisapride

Prescribing drug in the absence of proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to patient and increases risk of development of drug-resistant bacteria

Pregnancy Category: B

Lactation: unknown

Adults

15 mg/kg/day IV is FDA-approved; however, doses up to 22.5 mg/kg/day IV have been used off-label.

Geriatric

15 mg/kg/day IV is FDA-approved; however, doses up to 22.5 mg/kg/day IV have been used off-label.

Adolescents

15 mg/kg/day IV is FDA-approved; however, doses up to 22.5 mg/kg/day IV have been used off-label.

Children

12 years: 15 mg/kg/day IV is FDA-approved; however, doses up to 22.5 mg/kg/day IV have been used off-label.
1 to 11 years: Safety and efficacy have not been established; however, doses up to 22.5 mg/kg/day IV have been used off-label.

Infants

Safety and efficacy have not been established; however, doses up to 22.5 mg/kg/day IV have been used off-label.

Neonates

Safety and efficacy have not been established.

Quinupristin/dalfopristin

lyophilized powder for solution

  • 500mg (150mg/350mg) per vial
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