Journal of Antimicrobial Chemotherapy (2000) 46, 775-784
© 2000 The British Society for Antimicrobial Chemotherapy
Treatment of methicillin-resistant Staphylococcus aureus infections with quinupristin–dalfopristin in patients intolerant of or failing prior therapy
a Duke University Medical Center, Box 3306, Durham, NC 27710 and Campbell University School of Pharmacy, Buies Creek, NC, USA; b Duke University Medical Center, Durham, NC, c Bethesda Memorial Hospital, Boynton Beach, FL, USA; d Aventis Pharmaceuticals, Bridgewater, NJ, USA
Safety and efficacy of quinupristin–dalfopristin (an injectable streptogramin antibiotic) were evaluated in the treatment of a variety of infections due to methicillin-resistant Staphylococcus aureus (MRSA) in patients either intolerant of or failing prior therapy. The influence of resistance phenotypes on treatment outcome was also assessed. This worldwide, multicentre, open-label, non-comparative, emergency-use clinical study enrolled patients with one or more of nine predefined, culture-confirmed infections with MRSA, who had no clinically appropriate alternative antibiotic therapy. The recommended quinupristin–dalfopristin dose was 7.5 mg/kg administered iv every 8 h for a duration judged appropriate by the investigator. There were no restrictions on prior or concomitant treatment with other antibiotics. Clinical, microbiological and laboratory assessments were performed at baseline, during study drug treatment, within 24 h after the last dose, and 7–21 days post-therapy. Ninety patients [age (mean ± S.D.) 57.4 ± 18.5 years] with significant underlying medical illnesses were treated at 63 centres in five countries. The most common indications were bone and joint infection (44.4% of patients) and skin and skin structure infection (16.7%). The mean (± S.D.) daily dose and treatment duration was 20.2 ± 2.9 mg/kg/day for 28.5 ± 22.3 days, most frequently administered every 8 h. The overall success rate (defined as a clinical outcome of either cure or improvement and a bacteriological outcome of eradication or presumed eradication) was 71.1% in the all-treated population (n = 90) and 66.7% in patients who were both clinically and bacteriologically evaluable (n = 27). Success rates for endocarditis, respiratory tract infection and bacteraemia of unknown source were below the population mean. The macrolide–lincosamide–streptogramin type B resistance phenotype did not appear to alter the response rate. The most common non-venous adverse events related to study medication were arthralgias (10.8%), myalgias (8.6%) and nausea (8.6%). Quinupristin–dalfopristin should be considered as a treatment option for infections caused by MRSA, especially in patients intolerant of or failing alternate therapy.
* Corresponding author. Tel: + 1-919-681-6793; Fax: + 1-919-681-7494; E-mail: drew0001{at}mc.duke.edu
Synercid Emergency-Use Study Group Investigators are listed in the Appendix.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  H. M. Nguyen and C. J. Graber Limitations of antibiotic options for invasive infections caused by methicillin-resistant Staphylococcus aureus: is combination therapy the answer? J. Antimicrob. Chemother., January 1, 2010; 65(1): 24 - 36. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. M. Livermore Future directions with daptomycin J. Antimicrob. Chemother., November 1, 2008; 62(suppl_3): iii41 - iii49. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. J. REHM Staphylococcus aureus: The new adventures of a legendary pathogen Cleveland Clinic Journal of Medicine, March 1, 2008; 75(3): 177 - 192. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. A Mergenhagen and M. T Pasko Daptomycin Use After Vancomycin-Induced Neutropenia in a Patient with Left-Sided Endocarditis Ann. Pharmacother., September 1, 2007; 41(9): 1531 - 1535. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. S. J. Elliott, J. Foweraker, F. K. Gould, J. D. Perry, and J. A. T. Sandoe Guidelines for the antibiotic treatment of endocarditis in adults: report of the Working Party of the British Society for Antimicrobial Chemotherapy J. Antimicrob. Chemother., December 1, 2004; 54(6): 971 - 981. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Fuda, M. Suvorov, S. B. Vakulenko, and S. Mobashery The Basis for Resistance to {beta}-Lactam Antibiotics by Penicillin-binding Protein 2a of Methicillin-resistant Staphylococcus aureus J. Biol. Chem., September 24, 2004; 279(39): 40802 - 40806. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Sakoulas, P. A. Moise-Broder, J. Schentag, A. Forrest, R. C. Moellering Jr., and G. M. Eliopoulos Relationship of MIC and Bactericidal Activity to Efficacy of Vancomycin for Treatment of Methicillin-Resistant Staphylococcus aureus Bacteremia J. Clin. Microbiol., June 1, 2004; 42(6): 2398 - 2402. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. S. R. Darley and A. P. MacGowan Antibiotic treatment of Gram-positive bone and joint infections J. Antimicrob. Chemother., June 1, 2004; 53(6): 928 - 935. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M Turner, L. M Hakeem, K A. Lockman, D. N Bhattacharyya, and I. W Campbell Diabetic MRSA foot infection -- role of linezolid therapy The British Journal of Diabetes & Vascular Disease, January 1, 2004; 4(1): 44 - 46. [Abstract] [PDF]
|
|
|
|
 |
|
 T. Fujimura, Y. Yamano, I. Yoshida, J. Shimada, and S. Kuwahara In Vitro Activity of S-3578, a New Broad-Spectrum Cephalosporin Active against Methicillin-Resistant Staphylococci Antimicrob. Agents Chemother., March 1, 2003; 47(3): 923 - 931. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. A. Moise, A. Forrest, M. C. Birmingham, and J. J. Schentag The efficacy and safety of linezolid as treatment for Staphylococcus aureus infections in compassionate use patients who are intolerant of, or who have failed to respond to, vancomycin J. Antimicrob. Chemother., December 1, 2002; 50(6): 1017 - 1026. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 {blacktriangledown}Quinupristin + dalfopristin for infections DTB, February 1, 2002; 40(2): 15 - 16. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. L. Wald and M. D. Aronson Update in Hospital Medicine Ann Intern Med, December 18, 2001; 135(12): 1052 - 1060. [Full Text] [PDF]
|
|