Quinupristin + Dalfopristin
Indications
Quinupristin + Dalfopristin is used for:
Skin & Skin Structure Infection
Adult Dose
Intravenous
Skin & Skin Structure Infection
Indicated for complicated skin and skin structure infections caused by Staphylococcus aureus (methicillin susceptible) or Streptococcus pyogenes
7.5 mg/kg IV q12hr for at least 7 days
Child Dose
Skin & Skin Structure Infection
Indicated for complicated skin and skin structure infections caused by Staphylococcus aureus (methicillin susceptible) or Streptococcus pyogenes
<16 years: Safety and efficacy not established
>16 years: 7.5 mg/kg IV q12hr for at least 7 days
Renal Dose
Administration
IV Preparation
Reconstitute 500 mg-containing vial with 5 mL of D5W or SWI to obtain 100 mg/mL solution
Do not shake; swirl gently to dissolve while limiting foam formation
Dilute reconstituted solution within 30 min
Reconstituted solution should be added to at least 250 mL of D5W for peripheral administration (increase to 500 mL or 750 mL if necessary to limit venous irritation). Final conc NMT 2 mg/mL
An infusion volume of 100 mL may be used for central line infusions
Do not freeze solution
IV Administration
Flush with D5W before and after administration; incompatible with saline
Complete infusion over 1 hr (toxicity may be increased with shorter infusion)
If severe venous irritation occurs following peripheral administration of quinupristin/dalfopristin diluted in 250 mL D5W, consider increasing the infusion volume to 500 mL or 750 mL, changing the infusion site, or infusing by a peripherally inserted central catheter (PICC) or a central venous catheter
Contra Indications
Severe hepatic impairment. Hypersensitivity.
Precautions
Hepatic impairment and predisposition to cardiac arrhythmias.
Pregnancy-Lactation
Pregnancy Category: B
Lactation: unknown
Interactions
Increased risk of ventricular arrhythmias when used with drugs that prolong QT interval eg. astemizole, cisapride and terfenadine. May increase the serum levels of ciclosporin, nifedipine, midazolam and tacrolimus.
Adverse Effects
Side effects of Quinupristin + Dalfopristin :
>10%
Local pain (40-44%)
Inflammation at infusion site (38-42%)
Hyperbilirubinemia (3-35%)
Local edema (17-18%)
Infusion site reaction (12-13%)
1-10%
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%)
Mechanism of Action
Quinupristin/Dalfopristin works synergistically to inhibit bacterial protein synthesis by binding at different sites on the 50S subunit of the bacterial ribosome. Quinupristin works by inhibiting peptide chain elongation in the late phase of protein synthesis while dalfopristine works by inhibiting the peptidyl transferase in the early phase of protein synthesis.