Dalfopristin
Also known as: Pristinamycin IIA derivative, Quinupristin/Dalfopristin, RP 54476, Synercid
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Summary
Dalfopristin is a semisynthetic streptogramin A antibiotic used intravenously in combination with quinupristin (Synercid) for serious Gram‑positive infections, including MRSA and VRE.
Mechanism of Action
Binds to the 50S ribosomal subunit and inhibits bacterial protein synthesis; synergistic with quinupristin (streptogramin B).
Routes of Administration
Goals & Uses
- Bacteremia caused by susceptible Gram‑positive organismsAntibacterialHigh
- Vancomycin-resistant Enterococcus faecium (VREF) infectionsAntibacterialHigh
- Complicated skin and skin structure infections (cSSSI)AntibacterialHigh
- Hospital-acquired pneumonia (off-label)AntibacterialLow
- Complicated skin and skin‑structure infectionsAntibacterialHigh
Contraindications
- Severe hepatic impairment (Child‑Pugh C)Liver DiseaseModerate
- Hypersensitivity to streptogramin antibioticsAllergyHigh
- Concomitant use of CYP3A4-metabolized drugs with narrow therapeutic indexDrug InteractionHigh
- Hypersensitivity to streptograminsAllergyHigh
Adverse Effects
- Hypersensitivity reactionsImmunologicRare
- Elevated liver enzymes (AST/ALT)HepatotoxicityUncommon
- Infusion site reactions (pain, inflammation, thrombophlebitis)LocalCommon
- Nausea and vomitingGastrointestinalCommon
- Rash or pruritusDermatologicCommon
- Phlebitis at infusion siteLocal/vascularCommon
- Elevated liver enzymes (ALT, AST)HepaticUncommon
- Arthralgia and myalgiaMusculoskeletalCommon
- HyperbilirubinemiaHepaticCommon
Drug Interactions
- HMG-CoA reductase inhibitors (statins)Moderate
- MidazolamModerate
- CYP3A4 inducers (e.g., rifampin, carbamazepine)Moderate
- WarfarinModerate
- CyclosporineHigh
- TacrolimusHigh
- CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin)Moderate
Population Constraints
- Hepatic impairmentOrgan FunctionRelative
- Neonates and infants < 1 monthAgeAbsolute
- Pediatric patientsAgeRelative
- Pregnancy (Category B)PregnancyRelative
- Pregnant womenReproductiveRelative
Regulatory Status
- European UnionApprovedApproved: Serious infections caused by susceptible Gram‑positive organismsMarketed under the same combination product.
- United StatesApprovedApproved: Complicated skin and skin‑structure infections, Bacteremia caused by susceptible Gram‑positive bacteriaApproved as part of quinupristin/dalfopristin (Synercid) for IV use.
- United KingdomApprovedApproved: Vancomycin-resistant Enterococcus faecium infections, Complicated skin and skin structure infectionsAvailable as Synercid; used as reserve antibiotic for resistant organisms
Approved in the US and EU as part of the fixed‑dose combination quinupristin/dalfopristin; not marketed as a standalone product.
Evidence & Sources
No sources recorded yet.
Frequently Asked Questions
What is Dalfopristin?
Dalfopristin is a semisynthetic streptogramin A antibiotic used intravenously in combination with quinupristin (Synercid) for serious Gram‑positive infections, including MRSA and VRE.
What is Dalfopristin used for?
Dalfopristin is educationally associated with: Bacteremia caused by susceptible Gram‑positive organisms, Vancomycin-resistant Enterococcus faecium (VREF) infections, Complicated skin and skin structure infections (cSSSI), Hospital-acquired pneumonia (off-label), Complicated skin and skin‑structure infections. Educational only — not medical advice.
How is Dalfopristin administered?
Recorded routes of administration: Intravenous.
What are the potential side effects of Dalfopristin?
Reported adverse effects include: Hypersensitivity reactions, Elevated liver enzymes (AST/ALT), Infusion site reactions (pain, inflammation, thrombophlebitis), Nausea and vomiting, Rash or pruritus, Phlebitis at infusion site, Elevated liver enzymes (ALT, AST), Arthralgia and myalgia, Hyperbilirubinemia. This list is not exhaustive — consult a qualified clinician.
Who should avoid Dalfopristin?
Recorded contraindications: Severe hepatic impairment (Child‑Pugh C), Hypersensitivity to streptogramin antibiotics, Concomitant use of CYP3A4-metabolized drugs with narrow therapeutic index, Hypersensitivity to streptogramins. Consult a qualified clinician before use.