Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

PRIMAQUINEUsual DoseAdult: Malaria treatment: 15 mg base Q24H PO X 14 days (UWHC cost/day $1.21) or 45 mg base once a week PO X 8weeks (UWHC cost/dose $3.63).Malaria prophylaxis: 30 mg base PO Q24H beginning 1 day before departure and continuing for 7 days after leavingmalarious area (UWHC cost/day $2.42).Pneumocystis jiroveci treatment: 30 mg base Q24H PO X 21 days.Pediatric: Malaria treatment: 0.3 mg/kg/day PO X 14 days.Malaria prophylaxis: 0.5 mg base Q24H PO beginning 1 day before departure and continuing for 7 days after leavingmalarious area.Indications1. Malaria treatment.2. Malaria prophylaxis.3. Pneumocystis jiroveci treatment in combination with clindamycin in patients intolerant to conventional therapy.CommentsPrimaquine is contraindicated in pregnancy. Screen for G-6-PD status before initiating therapy. A 26.3 mg primaquinephosphate tablet equals 15 mg primaquine base.Drug Interactions• Aurothioglucose –increased risk of blood dyscrasias with concurrent administration• Levomethadyl – increased risk of QT prolongation, torsades de pointes or cardiac arrest with concurrentadministration• Grapefruit juice – increases C max and AUC of primaquine by approximately 20%Primaxin ® - see imipenem/cilastatin.QUINUPRISTIN/DALFOPRISTIN (Synercid ® ) – nonformulary at UWHC.Infectious Disease approval is required for all use of Synercid ® (See Appendix I)Usual DoseAdult: 7.5 mg/kg IV Q 8-12 hours (UWHC cost/day $348.65-523.03).Indications1. Symptomatic, laboratory-documented deep infections with vancomycin-resistant (MIC > 16 mcg/mL) Enterococcusfaecium (not faecalis) in patients who are unable to tolerate or are treatment failures on linezolid or daptomycin. Thepresence of infection is indicated by positive blood cultures or deep cultures from an intra-abdominal or deep surgicalwound specimen or bile, or a complicated urinary tract infection, associated with fever, leukocytosis, or other signs ofdeep infection (use Q8H dosing).2. Laboratory-documented methicillin-resistant Staphylococcus aureus in a patient unable to tolerate vancomycin orrefractory to parenteral therapy with vancomycin, with or without rifampin or other drugs or in a patient who is unable totolerate or is a treatment failure on linezolid or daptomycin (use Q12H dosing).CommentsEach dose should be infused over at least 60 minutes. Doses diluted in at least 250 mL D5W may be infused viaperipheral or central line. If the patient is fluid-restricted, the volume may be decreased to 100 mL and infused via centralline only. After completing infusion of the dose, flush the line with D5W. Heparin or saline flushes should not be used.Myalgia/arthralgia syndrome may be a dose-limiting side effect. Quinupristin/dalfopristin is usually a third-line agentbehind linezolid and daptomycin.Drug InteractionsQuinupristin/dalfopristin is a potent cytochrome P450 3A4 isoenzyme inhibitor and is likely to cause increases in serumlevel and AUC of most drugs that are metabolized through this pathway. The potential for increased toxicity exists.Caution and increased vigilance are indicated when concurrently administering such a drug if it has serious toxicities.