Quinupristin/dalfopristin

drugbox
IUPAC_name = Quinupristin: N- [(6"R",9"S",10"R",13"S",15a"S",18"R",22"S",24a"S")-22-
[p-(dimethylamino)benzyl] -6-ethyldocosahydro-10,23-dimethyl-5,8,12,15,17,21,24-heptaoxo-13-phenyl-18-
[(3"S")-3-quinuclidinylthio] methyl] -12"H"-pyrido [2,1-"f"] pyrrolo- [2,1-"l"] [1,4,7,10,13,16] oxapentaazacyclononadecin-9-yl] -3-hydroxypicolinamide
Dalfopristin:(3"R",4"R",5"E",10"E",12"E",14"S",26"R",26a"S")-26- [2-(diethylamino)ethyl] sulfonyl] -8,9,14,15,24,25,26,26a- octahydro-14-hydroxy-3-isopropyl-4,12-dimethyl-3"H"-21,18-nitrilo-1"H",22"H"-pyrrolo [2,1-"c"] [1,8,4,19] -dioxadiazacyclotetracosine-1,7,16,22(4"H",17"H")-tetrone


CAS_number = 120138-50-3
CAS_supplemental=CAS|112362-50-2
ATC_prefix = J01
ATC_suffix = FG02
PubChem = 6435782
DrugBank =
synonyms =
chemical_formula= quinupristin C₅₃H₆₇N₉O₁₀S
dalfopristin C₃₄H₅₀N₄O₉S
molecular_weight = quinupristin 1022.24 g/mol
dalfopristin 690.85 g/mol
bioavailability =
protein_bound = moderate
metabolism =
elimination_half-life = quinupristin 3.1 hours
dalfopristin 1 hour
excretion = 75% fecal, 15-19% urinary
pregnancy_category = B (U.S.)
legal_status = ℞-only (U.S.)
routes_of_administration = IV

Quinupristin/dalfopristin (Synercid) is a combination of two antibiotics used to treat infections by staphylococci and by vancomycin-resistant "Enterococcus faecium". It is not effective against "Enterococcus faecalis" infections.

Quinupristin and dalfopristin are both streptogramin antibiotics, derived from pristinamycin. Quinupristin is derived from pristinamycin I; dalfopristin from pristinamycin IIA. They are combined in a weight-to-weight ratio of 30% quinupristin to 70% dalfopristin.

Administration

Intravenous, usually 7.5 mg/kg every 8–12 hours

Mechanism of action

Dalfopristin inhibits the early phase of protein synthesis in the bacterial ribosome and quinupristin inhibits the late phase of protein synthesis (translocation). The combination of the two components acts synergistically and is more effective in vitro than each component alone.

Pharmacokinetics

Clearance by the liver, half-life 1–3 hours (with persistence of effects for 9–10 hours).

ide effects

#Joint aches (arthralgia) or muscle aches (myalgia)
#Nausea, diarrhea or vomiting
#Rash or itching
#Headache

References

*Allington DR, Rivey MP., "Quinupristin/dalfopristin: a therapeutic review.", Clin Ther. 2001 Jan;23(1):24-44. PMID 11219478.
*Lamb HM, Figgitt DP, Faulds D., "Quinupristin/dalfopristin: a review of its use in the management of serious gram-positive infections.", Drugs. 1999 Dec;58(6):1061-97. PMID 10651391.
*Manzella JP., "Quinupristin-dalfopristin: a new antibiotic for severe gram-positive infections.", Am Fam Physician. 2001 Dec 1;64(11):1863-6. PMID 11764864.
*Paradisi F, Corti G, Messeri D., "Antistaphylococcal (MSSA, MRSA, MSSE, MRSE) antibiotics.", Med Clin North Am. 2001 Jan;85(1):1-17. PMID 11190346.
*http://www.fda.gov/cder/consumerinfo/druginfo/SYNERCID.HTM