Letter to the Editor

Quinupristin–dalfopristin-induced Reticulocytopenic Anemia

Authors: Kirk M. Chan-Tack, MD, Sanjay Mehta, MD


Quinupristin-dalfopristin was approved by the FDA in 1999 for bacteremia and life-threatening infections with vancomycin-resistantEnterococcus faecium1 Other indications include complicated skin and soft-tissue infections with methicillin-susceptible Staphylococcus aureus and Streptococcus pyogenes2 Quinupristin-dalfopristin has also been used for methicillin-resistant S aureus, coagulase-negative staphylococcus, and Streptococcus pneumoniae3 Adverse drug events (ADEs) associated with quinupristin-dalfopristin include infusion-site reactions (42%), infusion-site pain (40%), edema (17%), arthralgias (47%), myalgias (6%), gastrointestinal effects (3 to 5%), rash (2.5%), headache (1.6%), pruritus (1.5%), and hyperbilirubinemia (25%).1,2 Reticulocytopenic anemia is a rare ADE from prolonged quinupristin-dalfopristin use. This report describes the third case of severe but reversible reticulocytopenic anemia due to quinupristin-dalfopristin.

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1.Moellering RC, Linden PK, Reinhardt l, et al. The efficacy and safety of quinupristin-dalfopristinfor the treatment of infections caused by vancomycin-resistant Enterococcusjaecium. J Antimicrob Chemother1999;44:251–261.
2.Nichols RL, Graham DR, Barriere SL, et al. Treatment of hospitalized patients with complicated gram':positive skin and soft tissue infections: two randomized, multi centre studies of quinupristin-dalfopristin versus cefazolin, oxacillin or vancomycin. Antimicrob Chemother 1999;44:263–273.
3.Jones RN, Ballow CH, Biedenbach DL, et al. Antimicrobial activity of quinupristin-dalfopristin tested against over 28,000 recent clinical isolates from 200 medical centers in the United States and Canada.Diagn Microbiol Infect Dis 1998;31:437–451.
4.Launay 0, Chemlal K, Andrieu V, et al. Severe reversible reticulocytopenic anemia associated with quinupristin-dalfopristin therapy. Clin Infect Dis 1997;25:156.
5.Evans PC, Almas JP, Criddle FJ. Anemia and reversible reticulocytopenia associated with extended quinupristin/dalfopristin. Ann Pharmacother 2004;38:720–721.
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