Quinupristin and Dalfopristin
Quinupristin/dalfopristin (Q/D) is given together in a fixed 30/70 combination; this combination has synergistic bactericidal activity against the following:
Q/D inhibits Enterococcus faecium, including vancomycin-resistant strains. Enterococcus faecalis is resistant.
Q/D is given via a central IV catheter because phlebitis frequently occurs when Q/D is given via a peripheral vein. Up to 30% of patients develop significant myalgias.
Dosage reduction is required for severe hepatic insufficiency but not for renal insufficiency.