Drug interactions -summary-

Cytochrome P450 3A inhibition-
avoid concomittant medications metabolised by cytochrome
P450 3A  that may prolong qTc interval

Nifedipine /Midazolam -
Coadministration of quinupristin/dalfopristin and nifedipine ( repeated oral dose ) and
midazolam ( IV bolus dose ) led to elevated plasma concentration of these drugs

Skin and skin structure infections

Life threatening infections

Adverse reactions-

Cardiovascular - palpitation, phelbitis

CNS - anxiety, confusion, dizziness, hypertonia, insomnia, leg cramps, paresthesia,
           vasodilation

Dermatologic- macropapular rash, sweating, urticaria

GI - constiption, dyspepsia, oral monoliasis, pancreatitis, peudomembrous enterocolitis
       stomatitis

GU - haematuria, vaginitis

Metabolic - Gout, peripheral edema

Musculoskeletal - arthalgia, myalgia, myasthenia

Respiratory - dyspnea, pleural effusion

Miscellaneous- abdominal pain, worsening of underlying illness, allergic reaction,
                           chest pain, fever, infection

Hypersensitivity to the drug or components

Special precaution/warnngs-

Pseudomembraneous colitis- has been reported with nearly all antibacterial agents, including
quinipristin.dafopristin. Consider this in patients who present with diarrhea susequent to
administeration of antibacterial agents.

Arthalgia/myalgias- some severe cases of arthalgia/myalgias have been reported in patients
with quinupristin/dalfopristin

Hyperbilirubinemia - elevation of total bilirubin more than 5 times the upper limit of normal
were noted in approximately 25% of the patients

Superinfection-Prolonged or repeated therapy of antibiotics may result in superinfection. Appropiate
measures should be taken if superinfection occurs.

Pregnancy- use during pregnancy only if clearly needed.

Lactation- exercise caution when administering to breast feeding woman

Children- safety and efficacy in patients younger than 16 years have not been established

Indication-

Skin and skin structure infections
Life threatening infections

Dosage-
7.5mg/kg IV every 12 hours

Children younger than 16 years of age- 7.5mg/kg IV every 8 to 12 years has been used in limited
number of children under emergency

Pharmacology-
Quinupristin/daflfropristin , a streptogramin antibacterial agent for IV administration is a sterile
lyophilised formulation of 2 semi-syntehetic pristinamycin derivative, quinipristin (derived from
pristinamycin I and dalfopristin ( derived from pristinamin II A)

Quinipristin /dalfopristin is bacteriostatic against E faecium and bactericidal against strains
of methicilin-susceptible and methicillin -resistent syaphylococci

Pregnancy-
Use during pregnancy only if clearly needed.

Lactation-
Exercise caution when administering to breast feeding woman

Children-
Safety and efficacy in patients younger than 16 years have not been established