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dalfopristin/quinupristin (Synercid)
Indications:
- bacterial infections due to susceptible organisms
- vancomycin-resistant Enterococcus faecium (VREF)
- methicillin-resistant Staphylococcus aureus (MRSA)
- methicillin-resistant Staphylococcus epidermidis (MRSE)
- FDA approved for treatment of life-threatening infections associated with:
a) VREF bacteremia
b) complicated skin & skin structure infections due to:
1] Staphylococcus aureus (methicillin sensitive)
2] Streptococcus pyogenes
- empiric treatment for fever of unknown origin [6]
Dosage:
1) 7.6 mg/kg IV every 8 hours
2) 10-20 mg/kg/day divided every 12 hours
Pharmacokinetics:
1) 75% excreted in feces
2) 20% excreted in urine
3) elimination 1/2life is 1.3-1.5 hours
4) no dosage adjustment needed for elderly [5]
Antimicrobial activity:
-> multidrug-resistant Gm+ bacteria
a) vancomycin resistant Enterococcus (VRE) {bacteriostatic}
b) methicillin-resistant Staphylococcus aureus (MRSA) {bacteriocidal} [5]
Adverse effects: (fairly toxic)
1) headache
2) nausea/vomiting
3) diarrhea
4) myositis
Drug interactions:
-> inhibits cyt P450 3A4
-> may increase levels of drugs metabolized by cyt P450 3A4
Mechanism of action:
1) acts on bacterial ribosome
2) inhibits both early & late protein synthesis
General
antibiotic combination
streptogramin
Database Correlations
PUBCHEM cid=5366
References
- Micromedex vol 101
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998
- Kaiser Permanente, Drug update 6/2000 & summer 2000
- Prescriber's Letter 13(3): 2006
Cytochrome P450 drug interactions
Detail-Document#: 220233
(subscription needed) http://www.prescribersletter.com
- Norman, D, In: UCLA Intensive Course in Geriatric Medicine
& Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- Deprecated Reference
Components
dalfopristin
quinupristin