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INTRODUCTION

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quinupristin/dalfopristin (kwin-oo-pris-tin/dal-foe-pris-tin)

Synercid

Classification

Therapeutic: anti-infectives

Pharmacologic: streptogramins

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Indications
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Treatment of serious or life-threatening infections associated with vancomycin-resistant Enterococcus faecium (VREF). Complicated skin/skin structure infections caused by Staphylococcus aureus (methicillin, susceptible) or Streptococcus pyogenes.

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Action
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Quinupristin inhibits the late phase of protein synthesis at the level of the bacterial ribosome; dalfopristin inhibits the early phase. Therapeutic Effects: Bacteriostatic effect against susceptible organisms. Spectrum: Active against vancomycin-resistant and multidrug-resistant strains of E. faecium, S. aureus (methicillin-susceptible), and S. pyogenes. Not active against E. faecalis.

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Adverse Reactions/Side Effects
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CNS: headache. CV: thrombophlebitis. GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea, vomiting.

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Derm: pruritus, rash.

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Local: edema/inflammation/pain at infusion site, infusion-site reactions. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS, pain.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor signs of pseudomembranous colitis, including diarrhea, abdominal pain, fever, pus or mucus in stools, and other severe or prolonged GI problems (nausea, vomiting, heartburn). Notify physician or nursing staff immediately of these signs.

  • Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

  • Assess any signs of thrombophlebitis, including localized pain, redness, or swelling in the affected area. Report these signs to the physician.

  • Monitor injection site for pain, swelling, and irritation. Report prolonged or excessive injection site reactions to the physician.

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Interventions
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  • Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection. Use universal precautions or isolation procedures as indicated for specific patients.

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Patient/Client-Related Instruction
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  • Advise patient about the likelihood of GI reactions such as nausea, vomiting, and diarrhea. Instruct patient to report severe or prolonged GI problems.

  • Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged headache, pain, or skin reactions (rash, itching).

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Pharmacokinetics
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Absorption: IV administration results in complete bioavailability.

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Distribution: Unknown.

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Protein Binding: Moderate.

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Metabolism and Excretion: Both are converted to compounds with additional anti-infective activity; parent drugs and metabolites are mostly excreted in feces (75–77%); 15% of quinupristin and 17% of dalfopristin excreted in urine.

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Half-life: Quinupristin—0.85 hr; dalfopristin—0.7 hr.

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TIME/ACTION PROFILE

ROUTE ONSET PEAK DURATION
IV rapid end of infusion 8–12 hr

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity.

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Use Cautiously in: Concurrent use of other drugs metabolized by the cytochrome P450 3A4 enzyme ...

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