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(kwih-NEW-priss-tin/dal-FOE-priss-tin)
Synercid
Injection, lyophilized: 500 mg (150 mg quinupristin; 350 mg dalfopristin)/10 mL
Class: Anti-infectives/Streptogramin

 Action Quinupristin inhibits the late phase of protein synthesis; dalfopristin inhibits the early phase of protein synthesis.

 Indications Treatment of serious or life-threatening infections associated with vancomycin-resistant Enterococcus faecium bacteria; treatment of complicated skin and skin structure infections caused by Staphylococcus aureus (methicillin-susceptible) or Streptococcus pyogenes.

 Contraindications Hypersensitivity to any component of product or prior hypersensitivity to other streptogramins.

 Route/Dosage

Vancomycin-Resistant Enterococcus Faecium

ADULTS AND CHILDREN (16 YR AND OLDER): IV 7.5 mg/kg, infused over a 60-min period, q 8 hr. Duration of therapy based on site and severity of infection.

Complicated Skin and Skin Structure Infection

ADULTS AND CHILDREN (16 YR AND OLDER): IV 7.5 mg/kg, infused over a 60-min period, q 12 hr for at least 7 days.

 Interactions

Drugs metabolized by cytochrome P450 3A4 (CYP3A4) enzyme system (eg, carbamazepine, cisapride, cyclosporine, delavirdine, diazepam, diltiazem, disopyramide, HMG-CoA reductase inhibitors [eg, simvastatin], docetaxel, indinavir, lidocaine, methylprednisolone, midazolam, nevirapine, nifedipine, paclitaxel, quinidine, ritonavir, tacrolimus, verapamil, vinca alkaloids [eg, vinblastine]): Plasma concentrations of these agents may be elevated, increasing or prolonging their therapeutic or adverse effects.

Avoid drugs metabolized by CYP3A4 and that prolong the QTc interval.

Incompatabilities: Saline solutions.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Thrombophlebitis; palpitations; phlebitis; vasodilation. CNS: Headache. DERM: Pain, edema and inflammation at infusion site; rash; pruritus. GI: Nausea; diarrhea; vomiting. GU: Hematuria. OTHER: Pain; abdominal pain; leg cramps; allergic reactions; chest pain.

 Precautions

Pregnancy: Category B. Lactation: Undetermined. Children: Safety and efficacy in children less than 16 yr not established. Pseudomembranous colitis: Consider in patients who develop diarrhea. Superinfection: May result in bacterial or fungal overgrowth of nonsusceptible microorganisms.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • For IV administration only. Not for intradermal, SC, or IM administration.
  • Follow manufacturer’s instructions for reconstituting the Powder for Injection and subsequent further dilution.
  • Dilute reconstituted solution within 30 min of reconstitution.
  • Do not administer if particulate matter, cloudiness, or discoloration noted.
  • Administer IV infusion over 60 min.
  • After completing IV infusion, flush vein with 5% Dextrose in Water to minimize vein irritation.
  • If other drugs are being administered through same IV line, flush IV line before and after infusion of quinupristin/dalfopristin with 5% Dextrose in Water solution.
  • Store vials in refrigerator (36° to 46°F). Store diluted solution for up to 5 hr at room temperature or 54 hr under refrigeration (36° to 46°F).

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies. Note history of hypersensitivity to quinupristin/dalfopristin or other streptogramins.
  • Review results of culture and sensitivity testing as available.
  • Assess venous access site for irritation. If moderate to severe irritation noted, change infusion site or infuse by peripherally inserted central catheter (PICC) or central venous catheter.
  • Monitor for signs of infection and for positive response to antibiotic therapy.
  • Monitor patient for signs and symptoms of anaphylactic or serious allergic reaction. Immediately discontinue infusion, notify health care provider, and be prepared to treat appropriately.
  • Monitor patient for GI, CNS, and general body side effects. Report to health care provider if noted and significant.

 Patient/Family Education

  • Explain name, dose, action, and potential side effects of drug.
  • Advise patient, family, or caregiver that medication will be prepared and administered by a health care provider in a health care setting.
  • Review dosing schedule and prescribed length of therapy with patient, family, or caregiver. Advise patient that dose and duration of therapy are dependent on site and cause of infection.
  • Advise patient that infusion site reaction, muscle pain, and joint pain are the most common side effects, and to inform health care provider if they occur and are intolerable.
  • Advise patient to report the following signs of superinfection to health care provider: black “furry” tongue, white patches in mouth, foul-smelling stools, vaginal itching, or discharge.
  • Warn patient, family, or caregiver that diarrhea containing blood or pus may be a sign of a serious disorder and to inform health care provider if noted.

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