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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