Dosing for "Dalfopristin/Quinupristin"
Dosing: Adult
Skin and skin structure infection, complicated: IV: 7.5 mg/kg every 12 hours for at least 7 days
Bacteremia (methicillin-resistant Staphylococcus aureus) (off-label use): IV: 7.5 mg/kg every 8 hours (Liu 2011). Note: May be considered with vancomycin failure and when reduced susceptibility to vancomycin and daptomycin is present.
Infective endocarditis (methicillin-resistant Staphylococcus aureus), treatment (off-label use): IV: 7.5 mg/kg every 8 hours with or without additional antibiotics (Chesi 2006; ESC [Habib 2015]). Additional data is necessary to further define the role of quinupristin/dalfopristin in the treatment of this condition.
Infective endocarditis (multidrug-resistant Enterococcus faecium), treatment (off-label use): IV: 7.5 mg/kg every 8 hours with other antibiotics (eg, high-dose ampicillin or the combination of doxycycline and rifampin) (ESC [Habib 2015]; Matsumura 1998; Thompson 2003)
Intravascular catheter-associated bloodstream infection (methicillin-resistant coagulase negative staphylococci or ampicillin- and vancomycin-resistant E. faecium) (off-label use): IV: 7.5 mg/kg every 8 hours (IDSA [Mermel 2009])
Meningitis, bacterial and ventriculitis (alternative adjunct to systemic therapy for vancomycin-resistant E. faecium) (off- label use): Note: Use a preservative-free preparation:
Intrathecal: 1 to 4 mg daily (Garey 2001).
Intraventricular: 2 mg daily (Tush 1998; Williamson 2002) or 2 to 5 mg daily (IDSA [Tunkel 2004]; IDSA [Tunkel 2017]; Tan 2000).
When administered via a ventricular drain, clamp drain for 15 to 60 minutes after administration (allows solution to equilibrate in cerebrospinal fluid [CSF]) (IDSA [Tunkel 2017]). Note: Intraventricular administration is generally reserved for use in patients who fail parenteral therapy despite removal of CSF shunt or when CSF shunt cannot be removed (Baddour 2018).
Dosing: Renal Impairment: Adult
No dosage adjustment necessary.
Dosing: Hepatic Impairment: Adult
There are no dosage adjustments provided in the manufacturer’s labeling. However, pharmacokinetic data suggest dosage adjustment may be necessary.