Medical Pharmacology Chapter 35  Antibacterial Drugs

Previous Page
Quinuprisin/dalfopristin (Synercid)

  • Overview

    • FDA-accelerated approval for:

      •  IV treatment of bacteremia & life-threatening infection due to vancomycin (Vancocin)-resistant Enterococcus faecium (VREF)

      •  Treatment of complicated skin & skin structure infections due to Staphylococcus aureus and Streptococcus pyrogenes

  •  Quinuprisin/dalfopristin (Synercid): properties

    • Two streptogramin antibacterials (30:70 combination)

    • Target: bacterial ribosomes

    • Effect: disruption of protein synthesis

  • Antibacterial Characteristics:

    • Active: against E. faecium (not against Enterococcus faecalis)

    • Active (in vitro): against methicillin (Staphcillin)-susceptible and-resistant S. aureus and S. epidermidis

    • Active (in vitro): against penicillin-susceptible &-resistant Streptococcus pneumoniae

    • Active (in vitro): against

      • Neisseria meningitidis, Moraxella cattarrhalis, Legionella pneumophila, Mycoplasma pneumoniae, Clostridium perfringens

  • Pharmacokinetics

    • IV administration

    • Hepatic metabolism

    • Biliary excretion

  • Some clinical trial results:

    • quinuprisin/dalfopristin (Synercid) --

      • As effective as vancomycin (Vancocin) in treating catheter-related bacteremia due to S. aureus

      • Effective in treatingVREF in aortic graft

      • Effective in treating a prosthetic valve

      • Effective in treating pericarditis is associated with continuous peritoneal dialysis

  •  Adverse Effects:

    •  Infusion site pain, inflammation, edema, thrombophlebitis -- frequency: 75%

    •  Arthralgias & myalgias: common, may be severe

    •  Drug-drug interactions

      • Quinuprisin/dalfopristin (Synercid) inhibitor of CYP3A4 (cytochrome P450 3A4) -- suggests cautious use in patients taking drugs metabolized by this enzyme

        • Increased serum nifedipine (Procardia, Adalat) concentration

        • Increased midazolam (Versed) serum concentration

        • Increased cyclosporine (Sandimmune, Neoral) serum concentration

        • Co-administration of quinuprisin/dalfopristin (Snercid) and drugs metabolized by CYP3A4 which may prolong Q-T intervals should be avoided (example: cisapride (Propulsid))

  • Clinical Use:  conclusion

    •  Quinuprisin/dalfopristin (Synercid) -- modestly effective for treatment of vancomycin (Vancocin)-resistant Enterococcus faecium bacteremia-- this effect may be life-saving

    •  High incidence of side effects and adverse drug-drug interactions suggest quinuprisin/dalfopristin (Synercid) should only rarely be used to treat any other type of infection

    The Medical Letter, climbed 41 (issue 1066), November 19, 1999, The Medical Letter Inc., New Rochelle, New York.

Previous Page
 
 

This Web-based pharmacology and disease-based integrated teaching site is based on reference materials, that are believed reliable and consistent with standards accepted at the time of development. Possibility of human error and on-going research and development in medical sciences do not allow assurance that the information contained herein is in every respect accurate or complete. Users should confirm the information contained herein with other sources. This site should only be considered as a teaching aid for undergraduate and graduate biomedical education and is intended only as a teaching site. Information contained here should not be used for patient management and should not be used as a substitute for consultation with practicing medical professionals. Users of this website should check the product information sheet included in the package of any drug they plan to administer to be certain that the information contained in this site is accurate and that changes have not been made in the recommended dose or in the contraindications for administration.  Advertisements that appear on this site are not reviewed for content accuracy and it is the responsibility of users of this website to make individual assessments concerning this information.  Medical or other information  thus obtained should not be used as a substitute for consultation with practicing medical or scientific or other professionals.