QUINUPRISTIN/DALFOPRISTIN

QUINUPRISTIN/DALFOPRISTIN
(quin-u-pris'tin/dal'fo-pris-tin)
Synercid
Classifications: antibiotic, streptogramin;
Therapeutic: antibiotic

Pregnancy Category: B

Availability

500 mg vial (150 mg quinupristin/350 mg dalfopristin)

Action

Streptogramin (cyclic macrolide) antibiotic that is produced by various Streptomyces bacteria. The site of action of both quinupristin and dalfopristin is the bacterial ribosome. Dalfopristin inhibits the early phase of protein synthesis of bacteria while quinupristin inhibits the late phase of protein synthesis of bacteria. This leads to death of the bacteria organisms.

Therapeutic Effect

Effectiveness indicated by clinical improvement in S&S of infection. Active against gram-positive pathogens including vancomycin-resistant Enterococcus faecium (VREF), as well as some gram-negative anaerobes.

Uses

Serious or life-threatening infections associated with VREF bacteremia; complicated skin and skin structure infections caused by Staphylococcus aureus or Streptococcus pyogenes.

Contraindications

Hypersensitivity to quinupristin/dalfopristin, pristinamycin, other streptogramins; children <16 y.

Cautious Use

Renal or hepatic dysfunction; pregnancy (category B); lactation.

Route & Dosage

Vancomycin-Resistant Enterococcus faecium
Adult: IV 7.5 mg/kg infused over 60 min q8h

Complicated Skin and Skin Structure Infections
Adult: IV 7.5 mg/kg infused over 60 min q12h x 7 d

Administration

Intravenous

PREPARE: Intermittent: Reconstitute a single vial by adding 5 mL D5W or sterile water for injection to yield 100 mg/mL. Gently swirl to dissolve but do NOT shake. Allow solution to clear. Withdraw the required dose and further dilute by adding to 100 mL (central line) or 250–500 mL (peripheral site) of D5W.  

ADMINISTER: Intermittent: Flush line before & after with D5W. Do NOT use saline. Administer over 1 h.  

INCOMPATIBILITIES Solution/additive: Saline solutions and lactated Ringer's solution (flush lines with D5W before infusing other drugs). Y-site: Any drugs diluted in saline.

  • Refrigerate unopened vials. After reconstitution solution is stable for 5 h at room temperature and 54 h refrigerated.

Adverse Effects (≥1%)

Body as a Whole: Headache, pain, myalgia, arthralgia. GI: Nausea, diarrhea, vomiting. Skin: Rash, pruritus. Other: Inflammation, pain, or edema at infusion site, other infusion site reactions, thrombophlebitis.

Interactions

Drug: Inhibits CYP3A4 metabolism of cyclosporine, midazolam, nifedipine, protease inhibitors, vincristine, vinblastine, docetaxel, paclitaxel, diazepam, tacrolimus, carbamazepine, quinidine, lidocaine, disopyramide.

Pharmacokinetics

Distribution: Moderately protein bound. Metabolism: Metabolized to several active metabolites. Elimination: Primarily in feces (75–77%). Half-Life: 3 h quinupristin, 1 h dalfopristin.

Nursing Implications

Assessment & Drug Effects

  • Monitor for S&S of infusion site irritation; change infusion site if irritation is apparent.
  • Monitor for cutaneous reaction (e.g., pruritus/erythema of neck, face, upper body).
  • Lab tests: C&S from site of infection prior to initiating therapy; WBC with differential; and liver function (especially with preexisting hepatic insufficiency).

Patient & Family Education

  • Report burning, itching, or pain at infusion site to physician.
  • Report any sensation of swelling of face and tongue; difficulty swallowing.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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