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Quinupristin-Dalfopristin

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61. Enterococcal Infections (Treatment)

of treatment for endocarditis, a 6-week rather than 4-week course of therapy is recommended. Combination therapy is also recommended to treat enterococcal meningitis, usually for at least 2-3 weeks. Intravenous linezolid or intravenous plus intraventricular quinupristin-dalfopristin have also been used to successfully treat meningitis. The emergence of enterococcal strains with multidrug-resistant determinants has significantly complicated the management of enterococcal infections. Vancomycin should (...) imipenem-cilastatin or ampicillin plus ceftriaxone may be considered. [ ] For E faecium infection, either linezolid or daptomycin may be effective, and quinupristin-dalfopristin or tigecycline could be considered. Surgical approaches may be necessary (see Surgical Care). For VRE infections, base the treatment on infection severity and in vitro susceptibility of the strain to other antibiotics. Uncomplicated UTIs have been treated successfully with nitrofurantoin. Isolates that remain relatively

2014 eMedicine.com

62. Peptostreptococcus Infection (Treatment)

with aerobic organisms, choose antimicrobial agents that treat both types of pathogens, taking into consideration their aerobic and anaerobic antibacterial spectrum and their availability in oral or parenteral form. [ , ] Penicillin G is most effective for treating anaerobic gram-positive cocci and microaerophilic streptococci. Other effective agents include other penicillins, cephalosporins, chloramphenicol, clindamycin, vancomycin, telithromycin, linezolid, quinupristin/dalfopristin, and carbapenems

2014 eMedicine.com

63. Infective Endocarditis (Treatment)

to achieve synergy against enterococci, but the practice of administering gentamicin for 5 days in the treatment of S aureus IV drug abuse (IVDA) IE should be questioned. Vancomycin-resistant isolates of Enterococcus faecium and Enterococcus faecalis (ie, vancomycin-resistant enterococci [VRE]) produce some of the most challenging nosocomial infections. Presently, no therapy has been proven highly effective for IE caused by strains of VRE. Quinupristin/dalfopristin (ie, Synercid) may suppress E faecium

2014 eMedicine.com

64. Mycobacterium Marinum (Overview)

Dermatol . 2005 Apr. 152(4):727-34. . Bråbäck M, Riesbeck K, Forsgren A. Susceptibilities of Mycobacterium marinum to gatifloxacin, gemifloxacin, levofloxacin, linezolid, moxifloxacin, telithromycin, and quinupristin-dalfopristin (Synercid) compared to its susceptibilities to reference macrolides and quinolones. Antimicrob Agents Chemother . 2002 Apr. 46(4):1114-6. . Edelstein H. Mycobacterium marinum skin infections. Report of 31 cases and review of the literature. Arch Intern Med . 1994 Jun 27. 154

2014 eMedicine.com

65. Streptococcus Group D Infections (Treatment)

, or the perils of revised nomenclature in bacteriology. Clin Infect Dis . 2005 Apr 1. 40(7):1070-1. . Ruoff KL, Miller SI, Garner CV, et al. Bacteremia with Streptococcus bovis and Streptococcus salivarius: clinical correlates of more accurate identification of isolates. J Clin Microbiol . 1989 Feb. 27(2):305-8. . Mouton JW, Endtz HP, den Hollander JG, et al. In-vitro activity of quinupristin/dalfopristin compared with other widely used antibiotics against strains isolated from patients with endocarditis. J

2014 eMedicine.com

66. Infective Endocarditis (Follow-up)

to achieve synergy against enterococci, but the practice of administering gentamicin for 5 days in the treatment of S aureus IV drug abuse (IVDA) IE should be questioned. Vancomycin-resistant isolates of Enterococcus faecium and Enterococcus faecalis (ie, vancomycin-resistant enterococci [VRE]) produce some of the most challenging nosocomial infections. Presently, no therapy has been proven highly effective for IE caused by strains of VRE. Quinupristin/dalfopristin (ie, Synercid) may suppress E faecium

2014 eMedicine.com

67. Mycobacterium Marinum (Follow-up)

of Mycobacterium marinum to gatifloxacin, gemifloxacin, levofloxacin, linezolid, moxifloxacin, telithromycin, and quinupristin-dalfopristin (Synercid) compared to its susceptibilities to reference macrolides and quinolones. Antimicrob Agents Chemother . 2002 Apr. 46(4):1114-6. . Edelstein H. Mycobacterium marinum skin infections. Report of 31 cases and review of the literature. Arch Intern Med . 1994 Jun 27. 154(12):1359-64. . El-Etr SH, Subbian S, Cirillo SL, et al. Identification of two Mycobacterium marinum

2014 eMedicine.com

70. Streptococcus Group D Infections (Follow-up)

. Saunders; 2007. 1713. van't Wout JW, Bijlmer HA. Bacteremia due to Streptococcus gallolyticus, or the perils of revised nomenclature in bacteriology. Clin Infect Dis . 2005 Apr 1. 40(7):1070-1. . Ruoff KL, Miller SI, Garner CV, et al. Bacteremia with Streptococcus bovis and Streptococcus salivarius: clinical correlates of more accurate identification of isolates. J Clin Microbiol . 1989 Feb. 27(2):305-8. . Mouton JW, Endtz HP, den Hollander JG, et al. In-vitro activity of quinupristin/dalfopristin

2014 eMedicine.com

71. Cellulitis (Follow-up)

IV q6-8h Meropenem 1 g IV q8h Ertapenem 1 g IV qd Cefotaxime 2 g IV q6h plus metronidazole 500 mg IV q6h or clindamycin 600-900 mg/kg IV q8h The following are first-line treatments in managing adult S aureus (MSSA) infections [ ] : Nafcillin (for patients with severe penicillin hypersensitivity: vancomycin, linezolid, quinupristin-dalfopristin, or daptomycin; add an appropriate agent in the presence of [or if there is a suspicion of] staphylococcal infection) or oxacillin 1-2 IV q4h Cefazolin 1 g (...) IV q8h Clindamycin 600-900 mg/kg IV q8h (may have cross-resistance and emergence resistance in erythromycin-resistant strains; induces resistance in MRSA) First-line agents in managing severe adult streptococcal infection are penicillin 2-4 MU IV every 4-6 hours plus clindamycin 600-900 mg/kg IV every 8 hours. [ ] For patients with severe penicillin hypersensitivity, use vancomycin, linezolid, quinupristin-dalfopristin, or daptomycin. Add an appropriate agent if a staphylococcal infection

2014 eMedicine.com

72. Cellulitis (Follow-up)

IV q6-8h Meropenem 1 g IV q8h Ertapenem 1 g IV qd Cefotaxime 2 g IV q6h plus metronidazole 500 mg IV q6h or clindamycin 600-900 mg/kg IV q8h The following are first-line treatments in managing adult S aureus (MSSA) infections [ ] : Nafcillin (for patients with severe penicillin hypersensitivity: vancomycin, linezolid, quinupristin-dalfopristin, or daptomycin; add an appropriate agent in the presence of [or if there is a suspicion of] staphylococcal infection) or oxacillin 1-2 IV q4h Cefazolin 1 g (...) IV q8h Clindamycin 600-900 mg/kg IV q8h (may have cross-resistance and emergence resistance in erythromycin-resistant strains; induces resistance in MRSA) First-line agents in managing severe adult streptococcal infection are penicillin 2-4 MU IV every 4-6 hours plus clindamycin 600-900 mg/kg IV every 8 hours. [ ] For patients with severe penicillin hypersensitivity, use vancomycin, linezolid, quinupristin-dalfopristin, or daptomycin. Add an appropriate agent if a staphylococcal infection

2014 eMedicine.com

73. Enterococcal Infections (Follow-up)

of treatment for endocarditis, a 6-week rather than 4-week course of therapy is recommended. Combination therapy is also recommended to treat enterococcal meningitis, usually for at least 2-3 weeks. Intravenous linezolid or intravenous plus intraventricular quinupristin-dalfopristin have also been used to successfully treat meningitis. The emergence of enterococcal strains with multidrug-resistant determinants has significantly complicated the management of enterococcal infections. Vancomycin should (...) imipenem-cilastatin or ampicillin plus ceftriaxone may be considered. [ ] For E faecium infection, either linezolid or daptomycin may be effective, and quinupristin-dalfopristin or tigecycline could be considered. Surgical approaches may be necessary (see Surgical Care). For VRE infections, base the treatment on infection severity and in vitro susceptibility of the strain to other antibiotics. Uncomplicated UTIs have been treated successfully with nitrofurantoin. Isolates that remain relatively

2014 eMedicine.com

74. Staphylococcal Infections (Diagnosis)

of staphylococcal infections (listed alphabetically, not necessarily in order of preference): Cefazolin Ceftaroline Cefuroxime Clindamycin Dalbavancin Daptomycin Dicloxacillin Doxycycline Linezolid Minocycline Nafcillin Oritavancin Quinupristin/dalfopristin Tedizolid Telavancin Tigecycline Trimethoprim-sulfamethoxazole Vancomycin Delafloxacin Surgery Abscesses must be drained and/or debrided. Infections involving a prosthetic joint usually require removal of the prosthesis. Other infections involving

2014 eMedicine.com

75. Streptococcus Group D Infections (Diagnosis)

with Streptococcus bovis and Streptococcus salivarius: clinical correlates of more accurate identification of isolates. J Clin Microbiol . 1989 Feb. 27(2):305-8. . Mouton JW, Endtz HP, den Hollander JG, et al. In-vitro activity of quinupristin/dalfopristin compared with other widely used antibiotics against strains isolated from patients with endocarditis. J Antimicrob Chemother . 1997 May. 39 Suppl A:75-80. . Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Bolger AF, Levison ME, et al. Infective endocarditis

2014 eMedicine.com

76. Enterococcal Infections (Diagnosis)

result in synergistic bactericidal activity against enterococci. The acquisition of vancomycin resistance by enterococci has seriously affected the treatment and infection control of these organisms. VRE, particularly E faecium strains, are frequently resistant to all antibiotics that are effective treatment for vancomycin-susceptible enterococci, which leaves clinicians treating VRE infections with limited therapeutic options. Newer antibiotics (eg, quinupristin-dalfopristin, linezolid, daptomycin (...) , tigecycline) with activity against many VRE strains have improved this situation, but resistance to these agents has already been described. A mutation (G2576U) in the domain V of the 23S rRNA is responsible for linezolid resistance, [ ] whereas resistance to quinupristin-dalfopristin may be the result of several mechanisms: modification of enzymes, active efflux, and target modification. Resistance of E faecalis and E faecium to daptomycin, a newer cyclic lipopeptide antibiotic that acts on the bacterial

2014 eMedicine.com

77. Enterococcal Infection (Follow-up)

, et al. Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med . 2009 Jan 1. 360(1):20-31. . Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals. Circulation . 2005 Jun 14. 111(23):e394-434. . . Bell EA. Quinupristin/dalfopristin: An interesting new antibiotics period. Infect Dis Child . 2000. 13(3):53. DiazGranados CA, Jernigan JA. Impact

2014 eMedicine Pediatrics

78. Enterococcal Infection (Treatment)

activity) are to be used in the following: Neonatal septicemia Endocarditis Meningitis Guidelines from the Infectious Diseases Society of America (IDSA) on intra-abdominal infections do not recommend empiric enterococcal coverage for community-acquired infections. [ ] However, for hospital-acquired abdominal infections, if enterococci are isolated, antibiotic coverage is recommended. For strains with high-level resistance to beta-lactams, aminoglycosides, and glycopeptides, quinupristin/dalfopristin (...) (Synercid) or linezolid (Zyvox) may be used. A 7-month-old formerly premature infant with ventriculitis secondary to E faecium who was successfully treated with a 3-week course of linezolid at a dose of 10 mg/kg/dose 3 times a day has been reported. Therapy was well tolerated. Resistance to linezolid can develop after prolonged antibiotic therapy (>21 days). Quinupristin/dalfopristin inhibits bacterial protein synthesis and is approved for patients older than 16 years for serious or life-threatening

2014 eMedicine Pediatrics

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