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Quinupristin and Dalfopristin

By Hans P. Schlecht, MD, MSc, Assistant Professor of Medicine, Department of Medicine, Division of Infectious Diseases & HIV Medicine, Drexel University College of Medicine ; Christopher Bruno, MD, Assistant Professor of Medicine, Division of infectious Diseases & HIV Medicine, Drexel University College of Medicine

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Quinupristin and dalfopristin are lincosamide antibiotics (see Lincosamides, Oxazolidinones, and Streptogramins) that are semisynthetic derivatives of pristinamycin, a naturally occurring streptogramin. Quinupristin/dalfopristin (Q/D) is given together in a fixed 30/70 combination; this combination has synergistic bactericidal activity against the following:

  • Streptococci and staphylococci, including strains resistant to other antibiotic classes

  • Some gram-negative anaerobic bacilli

  • Clostridium perfringens

  • Peptostreptococcus sp

  • Atypical respiratory pathogens (Mycoplasma pneumoniae, Chlamydophila pneumoniae, Legionella pneumophila)

Q/D inhibits Enterococcus faecium, including vancomycin-resistant strains. E. faecalis is resistant.

Q/D is given via a central IV catheter because phlebitis frequently occurs when Q/D is given via a peripheral vein. Up to 30% of patients develop significant myalgias.

Dosage reduction is required for severe hepatic insufficiency but not for renal insufficiency.

Q/D may inhibit the metabolism of drugs that are metabolized by the cytochrome P-450 (CYP450) 3A4 isoenzyme system.