Based on the Naranjo probability scale, the likelihood that quinupristin
dalfopristin caused the anemia and reticulocytopenia is probable.
These drugs are streptogamins which contain two component types, A and B, which are represented by dalfoprisitin and quinupristin
Overall, 12 (50%) of 24 of the VRE samples had high levels of gentamicin resistance, 3 (12%) of 25 were resistant to quinupristin (Synercid), 13 (54%) of 24 were resistant to tetracycline, and 20 (83%) of 24 were resistant to penicillin.
faecalis samples were resistant to quinupristin was of particular concern, since it is one of the few available options for treating VRE, Ms.
Although, as a streptogramin B, quinupristin
is cross-resistant with macrolides and lincosamides, dalfopristin is a streptogramin A and not part of this resistance pattern.
It is a novel, injectable antibiotic made of two molecules: quinupristin
The product is provided as a 30:70 ratio of quinupristin
(pristinamycin I A, a group B streptogramin) and dalfopristin (pristinamycin II A, a group A streptogramin) (1, 2).
New antibiotics to use against VRE have been developed such as linezolid, quinupristin
, tigecycline, daptomycin, and oritavancin.
We tested the following: penicillin, amoxicillin, piperacillin, piperacillin and tazobactam, cefotaxime, ceftazidime, ertapenem, imipenem, meropenem, doripenem, gentamicin, tobramycin, amikacin, levofloxacin, ciprofloxacin, moxifloxacin, minocycline, tygecycline, cotrimoxazole, fosfomycin, quinupristin
and dalfopristin, rifampin, daptomycin, linezolid, clindamycin, and fucidic acid.
Although all of these linezolid-resistant isolates were still sensitive to the drug combination of quinupristin
and dalfopristin (Synercid), the relatively high prevalence of linezolid resistance is "a cause for concern," said Paul C.
The two distinct antibiotic agents that form Synercid, quinupristin
and dalfopristin, work synergistically to inhibit or destroy susceptible bacteria through a two-pronged attack on protein synthesis in bacterial cells.
Serial cerebrospinal fluid samples were collected and showed that the levels attained in the cerebrospinal fluid of both the quinupristin
and dalfopristin components of Synercid exceeded the minimum inhibitory concentration for vancomycin-resistant Enterococcus faecium initially.