quinupristin-dalfopristin and Abdominal-Abscess

The pharmacodynamic and pharmacokinetic characteristics of antimicrobial agents are the two fundamental pharmacological components which provide a rationale for the choice of therapy for intraabdominal infections, and especially serious infections. The most important PK-PD parameters are well known which can potentiate therapeutic efficacy. Antimicrobial agents can be subdivided into categories based on whether their activity is dependent on concentration or exposure time. Therefore, a correct dosing regimen for the time-dependent molecules (i.e. beta-lactams, linezolid, tigecycline) should prolong the maximum exposure time to maintain serum levels over the minimum inhibitory concentration (MIC). The concentration-dependent molecules, on the other hand, which include aminoglycosides and fluoroquinolones, should be given in order to reach maximum concentrations, since they are bactericidal in direct proportion to their concentrations and possess a prolonged post-antibiotic effect.

Topics: Abdominal Abscess; Acetamides; Aminoglycosides; Anti-Bacterial Agents; Anti-Infective Agents; beta-Lactams; Digestive System Diseases; Drug Therapy, Combination; Fluoroquinolones; Humans; Linezolid; Metronidazole; Microbial Sensitivity Tests; Minocycline; Oxazolidinones; Peritonitis; Sepsis; Tigecycline; Treatment Outcome; Virginiamycin

Synercid (quinupristin/dalfopristin), the first semi-synthetic injectable streptogramin, is a promising alternative to glycopeptides against many Gram-positive multiresistant bacteria. Vancomycin is still considered an effective agent for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections but therapeutic failures with glycopeptides have been observed, even for the treatment of infections caused by S. aureus strains sensitive to vancomycin. Synercid, in combination with a glycopeptide, may address this problem without causing significant side effects due to the different toxicity patterns of the 2 antimicrobials. This study reports our experience with the combination of Synercid and vancomycin in 5 patients with severe infection caused by MRSA or methicillin-resistant coagulase-negative Staphylococcus.

Topics: Abdominal Abscess; Adult; Aged; Anti-Bacterial Agents; Coagulase; Drug Therapy, Combination; Endocarditis; Female; Heart-Assist Devices; Humans; Male; Methicillin; Methicillin Resistance; Microbial Sensitivity Tests; Middle Aged; Staphylococcal Infections; Staphylococcus aureus; Vancomycin; Virginiamycin