Pharmacokinetics of quinupristin/dalfopristin in patients with severe chronic renal insufficiency

Objective: To compare the pharmacokinetic profile of a single intravenous injection of quinupristin/dalfopristin, a new injectable streptogramin, in healthy young individuals and patients with severe chronic renal insufficiency. A secondary objective was to assess the relative tolerability of this dose in these patients compared with healthy individuals. Patients and participants: 13 patients with severe chronic renal insufficiency (creatinine clearance 6 to 28 ml/min/1.73m(2)) were individually matched for gender, bodyweight and age to a healthy volunteer. Methods: Participants received a single dose of quinupristin/dalfopristin 7.5 mg/kg bodyweight as a continuous 1-hour intravenous infusion, followed by serial blood sampling. Results: The disposition profile of unchanged quinupristin was similar in the 2 groups. However, the elimination of quinupristin derivatives in patients with renal impairment tended to be decreased: mean peak plasma drug concentration (C-max) and area under the concentration-time curve from zero to infinity (AUC(infinity)) of quinupristin plus its active derivatives were about 1.4 times higher in the patients with renal impairment compared with healthy volunteers. The mean C-max and AUC(infinity) of both unchanged dalfopristin and dalfopristin plus its active derivatives were about 1.3 times higher in renally impaired patients than in healthy volunteers. Adverse events were generally mild and transient. No severe or serious adverse events were reported and no participants prematurely discontinued the study. Venous tolerability tended to be better in healthy volunteers than in the patients with renal impairment. Conclusion: These results suggest that no formal reduction in the dosage of is necessary in patients with severe chronic renal impairment.