title: Experience with quinupristin/dalfopristin in treating infections with vancomycin-resistant Enterococcus faecium in children.
abstract: BACKGROUND
  The emergence and spread of vancomycin-resistant Enterococcus faecium (VREF) has presented serious therapeutic difficulties because of the lack of reliably active antibiotics. Quinupristin/dalfopristin is a new injectable streptogramin antibiotic that is active against most strains of VREF. Experience with this agent in adults with VREF infections is well-documented; however, there are few reports of its use in children. We report on eight children with VREF infections who received quinupristin/dalfopristin under a compassionate use protocol.
  
  
  METHODS
  Quinupristin/dalfopristin was administered according to the manufacturer's recommendations. Clinical and laboratory data were recorded for each patient.
  
  
  RESULTS
  The infections treated comprised six cases of bacteremia and two of peritonitis. All patients had serious underlying conditions. Seven patients recovered fully. One patient died, having experienced a relapse of his infection after quinupristin/dalfopristin was discontinued. None of the patients experienced side effects or other adverse events.
  
  
  CONCLUSIONS
  Quinupristin/dalfopristin was well-tolerated and generally effective in children with infections caused by VREF. There is increasing evidence that it may be more effective than other currently available antibiotics in some such patients.
authors.affiliation: Department of Microbiology, Birmingham Children's Hospital, UK. jim.gray@bhamchildrens.wmids.nhs.uk
authors.forename: J W
authors.initials: JW
authors.lastname: Gray
authors.forename: P J
authors.initials: PJ
authors.lastname: Darbyshire
authors.forename: S V
authors.initials: SV
authors.lastname: Beath
authors.forename: D
authors.initials: D
authors.lastname: Kelly
authors.forename: J R
authors.initials: JR
authors.lastname: Mann
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000627:therapeutic use*; D016984:Enterococcus faecium / Q000302:isolation & purification; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D006801:Humans; D007223:Infant; D008297:Male; D016896:Treatment Outcome; D020713:Vancomycin Resistance; D014769:Virginiamycin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014769:Virginiamycin; C113825:quinupristin; C113826:dalfopristin