Streptogramins for the treatment of infections caused by Gram-positive pathogens

ABSTRACT

Introduction

Streptogramins (pristinamycin and quinupristin-dalfopristin) can be interesting options for the treatment of infections due to Gram-positive cocci, especially multidrug-resistant isolates.

Areas covered

This review provides an updated overview of structural and activity characteristics, mechanisms of action and resistance, pharmacokinetic/pharmacodynamic, and clinical use of streptogramins.

Expert opinion

The streptogramin antibiotics act by inhibition of the bacterial protein synthesis. They are composed of two chemically distinct compounds, namely type A and type B streptogramins, which exert a rapid bactericidal activity against a wide range of Gram-positive bacteria (including methicillin-resistant staphylococci and vancomycin-resistant enterococci). Several mechanisms of resistance have been identified in staphylococci and enterococci but the prevalence of streptogramin resistance among clinical isolates remains very low. Even if only a few randomized clinical trials have been conducted, the efficacy of pristinamycin has been largely demonstrated with an extensive use for 50 years in France and some African countries. Despite its effectiveness in the treatment of severe Gram-positive bacterial infections demonstrated in several studies and the low rate of reported resistance, the clinical use of quinupristin-dalfopristin has remained limited, mainly due to its poor tolerance. Altogether, streptogramins (especially pristinamycin) can be considered as potential alternatives for the treatment of Gram-positive infections.

KEYWORDS:

• Streptogramin
• pristinamycin
• dalfopristin
• quinupristin
• MRSA
• VRE

Article highlights

• Streptogramins are a bactericidal combination of two compounds, streptogramins A and B that act synergistically by inhibition of bacterial protein synthesis.

• Two streptogramins (pristinamycin and quinupristin-dalfopristin) are currently used in human medicine.

• Streptogramins exhibit a rapid bactericidal activity against a wide range of Gram-positive bacteria (including multidrug-resistant isolates)

• Several mechanisms of resistance have been identified in staphylococci and enterococci but their prevalence among clinical isolates remains very low

• The efficacy of pristinamycin has been largely demonstrated due to its extensive use for 50 years in France and some African countries.

• The clinical use of quinupristin-dalfopristin has remained limited, mainly due to its poor tolerance

• Streptogramins (especially pristinamycin) can be considered as potential alternatives for the treatment of Gram-positive infections

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.