Treatment of vancomycin-resistant enterococcus with quinupristin/dalfopristin and high-dose ampicillin.

Abstract

OBJECTIVE:

To report the successful treatment of vancomycin-resistant Enterococcus (VRE) bacteremia using the combination of quinupristin/dalfopristin and high-dose ampicillin.

CASE SUMMARY:

A 38-year-old African American woman with relapsed acute myeloid leukemia and neutropenic fever developed VRE bacteremia following 3 successive courses of vancomycin for methicillin-resistant staphylococcal infections. Treatment with linezolid was initiated; however, after 9 days of therapy, blood cultures continued to reveal VRE and the patient became febrile. The patient was subsequently switched to quinupristin/dalfopristin and high-dose ampicillin. The fever resolved and all subsequent blood cultures were negative after the initiation of combination therapy.

DISCUSSION:

The emergence of VRE infections presents a treatment challenge in immunocompromised patients. When treating VRE infections in this patient population, the effectiveness of linezolid and quinupristin/dalfopristin is limited by their bacteriostatic activity when used as monotherapy. Recent in vitro data suggest synergistic activity with quinupristin/dalfopristin when used in combination with other antimicrobials in selected isolates of VRE.

CONCLUSIONS:

Persistent VRE bacteremia was successfully treated in this neutropenic patient using the combination of high-dose ampicillin and quinupristin/dalfopristin. Case reports and in vitro data suggest that concomitant therapy with high-dose ampicillin may be an effective treatment alternative for VRE infections not responding to standard therapy.

• Authors: J Audis Bethea, Christine M Walko, Patricia A Targos
• Journal: The Annals of pharmacotherapy (Ann Pharmacother) Vol. 38 Issue 6 Pg. 989-91 (Jun 2004) ISSN: 1060-0280 [Print] United States
• PMID: 15100393 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anti-Bacterial Agents
• Virginiamycin
• quinupristin-dalfopristin
• Ampicillin

Topics

• Adult
• Ampicillin (administration & dosage, therapeutic use)
• Anti-Bacterial Agents (administration & dosage, therapeutic use)
• Bacteremia (complications, drug therapy, microbiology)
• Drug Therapy, Combination
• Enterococcus faecium
• Female
• Humans
• Leukemia, Myeloid, Acute (complications, drug therapy)
• Neutropenia (complications)
• Staphylococcal Infections (complications, drug therapy)
• Vancomycin Resistance
• Virginiamycin (administration & dosage, therapeutic use)