Quinupristin/dalfopristin

Last updated
Quinupristin/dalfopristin
Quinupristin.png
Dalfopristin chemical structure.png
Quinupristin (top) and dalfopristin (bottom)
Combination of
Quinupristin Streptogramin antibiotic
Dalfopristin Streptogramin antibiotic
Clinical data
Pregnancy
category
Routes of
administration
IV
ATC code
Legal status
Legal status
Identifiers
CAS Number
PubChem CID
ChemSpider
 X mark.svgNYes check.svgY  (what is this?)    (verify)

Quinupristin/dalfopristin, or quinupristin-dalfopristin, (pronunciation: kwi NYOO pris tin / dal FOE pris tin) (trade name Synercid) is a combination of two antibiotics used to treat infections by staphylococci and by vancomycin-resistant Enterococcus faecium .

Contents

Quinupristin and dalfopristin are both streptogramin antibiotics, derived from pristinamycin. Quinupristin is derived from pristinamycin IA; dalfopristin from pristinamycin IIA. They are combined in a weight-to-weight ratio of 30% quinupristin to 70% dalfopristin. Discontinued 2022, there are no other manufacturers of this medication.

Administration

Intravenous, usually 7.5 mg/kg every 8 hours (infections/life threatening VRSA); every 12 hours (skin infections). No renal dosing adjustments, hepatic dosing adjustments are not defined, consider reducing dose.

Mechanism of action

Quinupristin and dalfopristin are protein synthesis inhibitors in a synergistic manner. While each of the two is only a bacteriostatic agent, the combination shows bactericidal activity.

Pharmacokinetics

Clearance by the liver CYP450:3A4 inhibitor, half-life quinupristin 0.8 hours, dalfopristin 0.7 hours (with persistence of effects for 9–10 hours).

Side effects

 [2] 

Serious:

  1. C.diff-associated diarrhea
  2. superinfection
  3. anaphylactoid reactions
  4. angioedema

Common:

  1. Joint aches (arthralgia) or muscle aches (myalgia)
  2. Nausea, diarrhea (C. diff associated) or vomiting
  3. Rash or itching
  4. Headache
  5. Hyperbilirubinemia
  6. Anemia
  7. Thrombophlebitis

Drug interactions

The drug inhibits P450 and enhances the effects of terfenadine, astemizole, indinavir, midazolam, calcium channel blockers, warfarin, cisapride and ciclosporin.

References

  1. 1 2 3 4 Denyer SP, Hodges N, Gorman SP, eds. (2004). Hugo and Russell's Pharmaceutical microbiology (7th ed.). Blackwell Science. p. 212. ISBN   978-0-632-06467-0.
  2. Epocrates v 19.5

Further reading