In recent years there has been a dramatic worldwide increase in the prevalence of multiple
drug-resistant strains of common Gram-positive bacteria. This highlights the need for a new class of
antibiotic with activity against these organisms.
Quinupristin/dalfopristin, the first
injectable streptogramin antibiotic, has a unique spectrum of activity, encompassing most Gram-positive cocci (including multi-
drug-resistant strains), respiratory pathogens and anaerobes, Gram-positive, and a prolonged post-
antibiotic effect.
Quinupristin/ dalfopristin is active in vitro against multi-
drug-resistant isolates of Staphylococcus aureus,
coagulase-negative staphylococci,
penicillin-resistant pneumococci and
vancomycin-resistant Enterococcus faecium. Clinical case reports have shown that the combination is active against intra-abdominal, aortic graft, bacteraemia and
hydrocephalus shunt
infections caused by multi-
drug-resistant enterococci, particularly E. faecium. In almost all of these clinical situations the enterococcal
infection had displayed resistance to all other antimicrobial
therapies. Preliminary clinical data have demonstrated the activity of
quinupristin/ dalfopristin against S. aureus bacteraemia, and
quinupristin/dalfopristin may also prove useful in the treatment of
pneumococcal infections. Thus, possible future applications of the combination include the treatment of multi-
drug-resistant strains of staphylococci, streptococci and enterococci.
Quinupristin/dalfopristin may prove useful in the treatment of
staphylococcal infections in children, invasive systemic
pneumococcal infections, and nosocomial and community-acquired Gram-positive
infections in patients unable to tolerate
beta-lactam antimicrobial agents or
glycopeptide antibiotics.