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Pristinamycin
See also Streptogramins
General information
Pristinamycin is a combination of streptogramin A (pristinamycin IIA) and streptogramin B (pristinamycin IB), derived from Streptomyces pristinaespiralis [ ]. The former is a polyunsaturated macrolactone and the latter is a peptidic macrolactone or depsipeptide. Group A and group B streptogramins are both bacteriostatic by reversible binding of the 50S subunit of 70S bacterial ribosomes. Together, however, they are synergistic and bactericidal.
Pristinamycin is active against the main bacteria that cause respiratory tract infections and has been used in the treatment of acute or recurrent sinusitis, community-acquired pneumonia, and periodontal infection with Actinobacillus actinomyectemcomitans [ ].
Drug studies
Observational studies
In a prospective study in 53 patients with methicillin-resistant Staphylococcus aureus treated with pristinamycin 0.5–1.5 g tds, adverse reactions included diarrhea or loose stools (n = 8) and one possible rash. Another patient had an infection with Clostridium difficile more than 1 month after therapy [ ].
In a retrospective chart review of 27 patients with osteoarticular infections, there were adverse reactions to pristinamycin in eight cases; seven were gastrointestinal disturbances and there was one instance of an allergic rash, which required drug withdrawal [ ].
In a retrospective case note review of 36 patients who had received pristinamycin for resistant Gram-positive bacterial infections, 11 reported adverse reactions [ ]. Seven required drug withdrawal after a median of 31 days because of intolerable adverse reactions; three because of gastrointestinal reactions, one because of a rash, and one because of neutropenia.
Organs and systems
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