Experience with quinupristin/dalfopristin in treating infections with vancomycin-resistant Enterococcus faecium in children

Background. The emergence and spread of vancomycin-resistant Enterococcus f aecium (VREF) has presented serious therapeutic difficulties because of the lack of reliably active antibiotics. Quinupristin/dalfopristin is a new in jectable streptogramin antibiotic that is active against most strains of VR EF. Experience with this agent in adults with VREF infections is well-docum ented; 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 recom mendations. Clinical and laboratory data were recorded for each patient. Results. The infections treated comprised six cases of bacteremia and two o f peritonitis. All patients had serious underlying conditions. Seven patien ts recovered fully. One patient died, having experienced a relapse of his i nfection after quinupristin/dalfopristin was discontinued. None of the pati ents experienced side effects or other adverse events. Conclusion. Quinupristin/dalfopristin was well-tolerated and generally effe ctive in children with infections caused by VREF. There is increasing evide nce that it may be more effective than other currently available antibiotic s in some such patients.