Implications of Vancomycin Degradation Products on Therapeutic Drug Monitoring in Patients with End‐Stage Renal Disease

Pharmacotherapy - Tập 19 Số 6 - Trang 702-707 - 1999
A. R. Somerville1, David H. Wright1,2, John C. Rotschafer1,2
1College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
2Regions Hospital, Department of Clinical Pharmacy, St. Paul, Minnesota.

Tóm tắt

In renally impaired patients, vancomycin concentrations typically are maintained at body temperature for extended periods of time due to the drug's prolonged half‐life. Both time and increased temperature potentiate production of vancomycin crystalline degradation products (CDP‐1). Commercially available vancomycin assays, such as fluorescence polarization immunoassay (FPI) and radioimmunoassay, cross‐react with CDP‐1 isomers. Overestimation of vancomycin concentrations by 40–53% due to cross‐reactivity of CDP‐1 with active factor B vancomycin occurs with FPI. As FPI is the most common method of analyzing serum vancomycin, clinicians must be aware of its potential shortcomings and be prepared to alter vancomycin dosages in renally impaired patients. The possibility of adverse affects due to elevated concentrations of CDP‐1 or therapeutic failures due to subtherapeutic levels of factor B vancomycin cannot be excluded.

Từ khóa


Tài liệu tham khảo

10.1093/jac/14.suppl_D.1

10.1128/AAC.22.3.391

10.1097/00007691-198706000-00015

10.1128/AAC.42.5.1303

10.2165/00003088-199120060-00003

10.1093/clinids/18.4.533

10.1093/clinids/18.4.544

10.1093/jac/22.5.739

Yeo K‐T, 1989, Clinical performance of the EMIT vancomycin assay, Clin Chem, 35, 1504, 10.1093/clinchem/35.7.1504

10.1097/00007691-198909000-00017

10.1097/00007691-199011000-00009

Hortin GL, 1991, Cross‐reactivity of a vancomycin degradation product in three immunoassays of vancomycin, Clin Chem, 37, 2009, 10.1093/clinchem/37.11.2009a

10.1016/S0272-6386(96)90032-3

10.1097/00007691-199602000-00013

10.1021/ja00361a029

10.1021/jm00325a004

10.7326/0003-4819-94-3-343

Hammett‐Stabler CA, 1998, Laboratory guidelines for monitoring of antimicrobial drugs, Clin Chem, 44, 1129, 10.1093/clinchem/44.5.1129

Pfaller MA, 1984, Laboratory evaluation of five assay methods for vancomycin: bioassay, high‐pressure liquid chromatography, fluorescence polarization immunoassay, radioimmunoassay, and fluorescence immunoassay, J Clin Microbiol, 20, 311, 10.1128/jcm.20.3.311-316.1984

SmithPF PetrosWP SoucieMP CopelandKR.Falsely elevated vancomycin concentrations in endstage renal disease: lack of cross‐reactivity with a modified FPIA assay [abstr]. Presented at the annual meeting of the American College of Clinical Pharmacy Phoenix AZ November 912 1997.

10.1097/00007691-199804000-00016

Geraci JE, 1958, Antibiotic therapy of bacterial endocarditis. VII. Vancomycin for acute micrococcal endocarditis, Proc Staff Meet Mayo Clin, 33, 172

10.1093/jac/36.2.279

Rodvold KA, 1987, Routine monitoring of serum vancomycin concentrations: can waiting be justified?, Clin Pharm, 6, 655

10.1128/AAC.32.4.454

10.1128/AAC.34.10.1869

10.1128/AAC.36.8.1766

10.1128/AAC.32.6.848

Thông tin
Thông tin xuất bản

Pharmacotherapy

Tập 19 Số 6

702-707

Thông tin tác giả