Document Detail


Quinupristin/Dalfopristin therapy for infections due to vancomycin-resistant Enterococcus faecium.
MedLine Citation:
PMID:  10817685     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The efficacy and safety of quinupristin/dalfopristin for treatment of infections due to vancomycin-resistant Enterococcus faecium were evaluated in 24 hospitalized patients with documented infections (19 bacteremias, 5 localized infections) caused by vancomycin-resistant E. faecium that was susceptible to quinupristin/dalfopristin in vitro. Patients received iv quinupristin/dalfopristin at a dosage of either 7.5 mg/kg every 8 h or 5 mg/kg every 8 h. A favorable clinical response (cure or improvement) occurred in 19 (83%) of 23 evaluable patients; bacteriologic eradication occurred in 17 (74%) of 23 evaluable patients. A favorable clinical response was observed in 12 (80%) of 15 patients who were treated with 7.5 mg/kg of quinupristin/dalfopristin every 8 h and in 7 (88%) of 8 patients treated with 5 mg/kg of quinupristin/dalfopristin every 8 h. Two of four treatment failures were associated with a decrease in the in vitro susceptibility of vancomycin-resistant E. faecium to quinupristin/dalfopristin. Superinfections developed in 6 patients (26%), but only one was caused by Enterococcus faecalis that was resistant to quinupristin/dalfopristin. Myalgias and arthralgias were the only adverse events related to quinupristin/dalfopristin. These conditions occurred in 8 (33%) of 24 patients and were dose-related (8 cases in 16 patients treated with 7.5 mg/kg of quinupristin/dalfopristin every 8 h, no cases in 8 patients treated with 5 mg/kg every 8 h). Mortality associated with vancomycin-resistant E. faecium infection was 17% (4 of 23 patients), whereas mortality from other causes was 52% (12 of 23 patients). These results suggest that quinupristin/dalfopristin is effective as treatment for vancomycin-resistant E. faecium infections in critically ill patients with serious underlying conditions. Except for myalgias and arthralgias at higher dosages, the drug is well-tolerated.
Authors:
D J Winston; C Emmanouilides; A Kroeber; J Hindler; D A Bruckner; M C Territo; R W Busuttil
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't     Date:  2000-05-18
Journal Detail:
Title:  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America     Volume:  30     ISSN:  1058-4838     ISO Abbreviation:  Clin. Infect. Dis.     Publication Date:  2000 May 
Date Detail:
Created Date:  2000-08-24     Completed Date:  2000-08-24     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9203213     Medline TA:  Clin Infect Dis     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  790-7     Citation Subset:  IM    
Affiliation:
Department of Medicine, Division of Hematology-Oncology, UCLA Medical Center, Los Angeles, CA 90095, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Anti-Bacterial Agents / pharmacology
Child
Child, Preschool
Drug Therapy, Combination / pharmacology,  therapeutic use*
Enterococcus faecium / drug effects*
Female
Gram-Positive Bacterial Infections / drug therapy*,  mortality
Hospitalization
Humans
Infant
Male
Microbial Sensitivity Tests
Middle Aged
Treatment Outcome
Vancomycin Resistance*
Virginiamycin / pharmacology,  therapeutic use*
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 11006-76-1/Virginiamycin; 126602-89-9/quinupristin-dalfopristin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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