Last update Feb. 3, 2025

Quinupristin Mesilate / Dalfopristin Mesilate

Likely Compatibility

Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.

Quinupristin and dalfopristin are streptogramin antibacterial semisynthetic derivatives of pristinamycin I and IIA. They are used in combination in a 3:7 ratio for the treatment of severe infections with multidrug-resistant gram-positive bacteria, specifically MRSA and vancomycin-resistant Enterococcus faecium. Intravenous administration every 8 to 12 hours.

At the time of the last update, we found no published data on its excretion in breast milk.

Its pharmacokinetic data (high molecular weight and large volume of distribution) make it unlikely to pass into breast milk in clinically significant quantities (Hale, Mitrano 2009, Chin 2000), although the low binding to plasma proteins could favor it.

Its low oral bioavailability makes it difficult for it to pass into infant plasma from ingested breast milk, except in premature infants and the immediate neonatal period in which there may be greater intestinal permeability.

Monitor the appearance of vomiting, diarrhea or jaundice in the infant. Although rare, the possibility of transient gastroenteritis due to altered intestinal flora in infants whose mothers take antibiotics should be considered. (Briggs 2015, Ito 1993)

Until more published data on this drug in relation to lactation are known, safer alternatives may be preferable, especially during the neonatal period and in case of prematurity.


See below the information of this related product:

  • Pristinamycin (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)

Alternatives

  • Clindamycin (Safe product and/or breastfeeding is the best option.)
  • Doxycycline (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)
  • Linezolid (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)
  • Trimethoprim-Sulfamethoxazole (TMP-SMX; TMP-SMZ) (Safe product and/or breastfeeding is the best option.)
  • Vancomycin (Safe product and/or breastfeeding is the best option.)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Quinupristin Mesilate / Dalfopristin Mesilate in other languages or writings:

Group

Quinupristin Mesilate / Dalfopristin Mesilate belongs to this group or family:

Tradenames

Main tradenames from several countries containing Quinupristin Mesilate / Dalfopristin Mesilate in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 0 / 0 %
Molecular weight Q: 1118 / D: 787 daltons
Protein Binding Q: 55 - 78 / D: 11 - 26 %
VD Q: 0.45 / D: 0.24 l/Kg
pKa Q: 7.45 / D: 13.17 -
Tmax 1 hours
Q: 1 - 3 / D: 0.7 hours

References

  1. Hale TW. Medications & Mothers' Milk. 1991- . Springer Publishing Company. Available from https://www.halesmeds.com Consulted on April 10, 2024 Full text (link to original source)
  2. Briggs GG, Freeman RK, Towers CV, Forinash AB. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. Wolters Kluwer Health. Tenth edition (acces on line) 2015
  3. Mitrano JA, Spooner LM, Belliveau P. Excretion of antimicrobials used to treat methicillin-resistant Staphylococcus aureus infections during lactation: safety in breastfeeding infants. Pharmacotherapy. 2009 Sep;29(9):1103-9. Abstract
  4. Chin KG, Mactal-Haaf C, McPherson CE. Use of anti-infective agents during lactation: Part 1--Beta-lactam antibiotics, vancomycin, quinupristin-dalfopristin, and linezolid. J Hum Lact. 2000 Abstract
  5. Ito S, Blajchman A, Stephenson M, Eliopoulos C, Koren G. Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication. Am J Obstet Gynecol. 1993 May;168(5):1393-9. Abstract

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