Journal of Antimicrobial Chemotherapy, Vol 39, 139-143, Copyright © 1997 by The British Society for Antimicrobial Chemotherapy
E Rubinstein and F Bompart
In recent years there has been a dramatic worldwide increase in the
prevalence of multiple drug-resistant strains of common Gram-positive
bacteria. This highlights the need for a new class of antibiotic with
activity against these organisms. Quinupristin/dalfopristin, the first
injectable streptogramin antibiotic, has a unique spectrum of activity,
encompassing most Gram-positive cocci (including multi-drug-resistant
strains), respiratory pathogens and anaerobes, Gram-positive, and a
prolonged post-antibiotic effect. Quinupristin/ dalfopristin is active in
vitro against multi-drug-resistant isolates of Staphylococcus aureus,
coagulase-negative staphylococci, penicillin-resistant pneumococci and
vancomycin-resistant Enterococcus faecium. Clinical case reports have shown
that the combination is active against intra- abdominal, aortic graft,
bacteraemia and hydrocephalus shunt infections caused by
multi-drug-resistant enterococci, particularly E. faecium. In almost all of
these clinical situations the enterococcal infection had displayed
resistance to all other antimicrobial therapies. Preliminary clinical data
have demonstrated the activity of quinupristin/ dalfopristin against S.
aureus bacteraemia, and quinupristin/dalfopristin may also prove useful in
the treatment of pneumococcal infections. Thus, possible future
applications of the combination include the treatment of
multi-drug-resistant strains of staphylococci, streptococci and
enterococci. Quinupristin/dalfopristin may prove useful in the treatment of
staphylococcal infections in children, invasive systemic pneumococcal
infections, and nosocomial and community-acquired Gram-positive infections
in patients unable to tolerate beta-lactam antimicrobial agents or
glycopeptide antibiotics.
ORIGINAL ARTICLES
Activity of quinupristin/dalfopristin against gram-positive bacteria: clinical applications and therapeutic potential
Chaim Sheba Medical Center, Tel Aviv University School of Medicine, Israel.
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