Pristinamycin

Summary

Pristinamycin is a naturally derived streptogramin antibiotic mixture produced by Streptomyces pristinaespiralis, composed of pristinamycin I (a macrolactone depsipeptide, streptogramin B) and pristinamycin II (an unsaturated polyketide-peptide, streptogramin A). It is approved in France and some other countries for oral treatment of staphylococcal and streptococcal infections, including skin and soft tissue infections. Its synergistic two-component mechanism confers bactericidal activity and a low propensity for resistance development. It is a predecessor to the injectable semi-synthetic derivative quinupristin/dalfopristin (Synercid).

Mechanism of Action

Inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit; pristinamycin I (streptogramin B) and pristinamycin II (streptogramin A) act synergistically, with pristinamycin II binding first and enhancing pristinamycin I binding, resulting in irreversible inhibition of the elongation phase of translation

Routes of Administration

Goals & Uses

• Treatment of MRSA infectionsAntimicrobialModerate
• Community-acquired pneumonia (mild)Respiratory InfectionLow
• Treatment of streptococcal infectionsAntimicrobial / Infectious DiseaseHigh
• Penicillin-allergic patient infectionsAntimicrobial / Infectious DiseaseModerate
• Treatment of staphylococcal skin and soft tissue infectionsAntimicrobial / Infectious DiseaseHigh

Contraindications

• Severe hepatic impairmentOrganModerateLiver function concerns
• Hypersensitivity to pristinamycin or other streptograminsAllergyHigh
• Pregnancy (especially first trimester)ReproductiveModerate

Adverse Effects

• AnaphylaxisImmunologicRareSevere life-threatening allergic reaction
• Skin rash / urticariaDermatologicalUncommon
• NauseaGastrointestinalCommonFeeling of sickness or urge to vomit
• VomitingGastrointestinalCommonForceful expulsion of stomach contents
• Elevated liver enzymesHepaticUncommonIncrease in AST/ALT or other hepatic markers
• DiarrheaGastrointestinalCommonLoose or frequent stools

Drug Interactions

• WarfarinModerate
• CyclosporineHigh
• Ergot alkaloidsHigh
• Statins (e.g., simvastatin)Moderate

Population Constraints

• PregnancyReproductive SafetyRelative
• Hepatic impairmentOrgan FunctionRelative
• Pediatric patients (< 6 years)PediatricRelative
• BreastfeedingReproductiveRelative

Regulatory Status

• European UnionApprovedApproved: Staphylococcal skin and soft tissue infections, Streptococcal infectionsApproved primarily in France (Pyostacine); not centrally EMA-approved as a EU-wide product
• United StatesUnapprovedPristinamycin itself is not FDA-approved; semi-synthetic derivative quinupristin/dalfopristin (Synercid) is FDA-approved for IV use
• United KingdomUnknownNot listed as a UK-licensed product post-Brexit; availability limited

Approved in France (brand name Pyostacine) since the 1960s; not approved by the US FDA or EMA as a standalone product. Quinupristin/dalfopristin, a semi-synthetic IV derivative, is FDA-approved. Pristinamycin is used primarily in France and some European countries.

Evidence & Sources

No sources recorded yet.