Chapter e1

Streptogramins

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Synercid, the one approved streptogramin, is a combination of two synthetic derivatives of pristinamycin—quinupristin and dalfopristin—in a 30:70 ratio that is administered intravenously. It is bactericidal and inhibits protein synthesis by binding to bacterial ribosomes. Its major clinical use is in the therapy of gram-positive infections, particularly methicillin-resistant S aureus and S epidermidis and enterococci, including vancomycin-resistant E faecium. The combination is not reliably active against E faecalis. The recommended dose is 7.5 mg/kg/dose intravenously every 8 hours. In addition to phlebitis with peripheral administration, the major adverse effect is arthralgias and myalgias, which resolve with discontinuation of the drug. It is primarily cleared via the liver; streptogramins inhibit the cytochrome P450 system, resulting in increased levels of cyclosporine and other agents. With the availability of linezolid and daptomycin, the indications for this agent are extremely limited.

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