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Article Review/Hyperlink
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Follin SL, Mueller BA, Scott MK, Carfagna MA, Kraus MA
Falsely elevated serum vancomycin concentration in hemodialysis
patients
Am J Kidney Dis
(Jan) 27:67-74 1996

The elimination kinetics of vancomycin are variable in patients
with renal failure. Elimination by residual renal function, assay
variability, and changes in volume of distribution contribute to
the difficulty in achieving desired peak and trough levels. These
investigators measured vancomycin levels in eight hemodialysis
patients. They compared the levels measured by fluorescence
polarization immunoassay (FPIA) to those measured by enzyme
multiplied immunoassay (EMIT). They found that FPIA levels were
consistently higher than those measured using EMIT. The
investigators conclude that FPIA overestimates vancomycin levels
because the polyclonal antibody used in the FPIA assay also
measures microbiologically inactive crystalline degradation
products, while the monoclonal antibody used in the EMIT assay
does not.
Comment: This paper emphasizes the need for accurate
measurements of antibiotic blood levels to avoid ineffective
therapy or drug toxicity. However, the investigators compared two
indirect measurements of vancomycin blood levels. Their
conclusion that FPIA measured blood levels are less accurate
than EMIT measured levels would be substantially strengthened had
they included comparisons with blood levels measured using
high-performance liquid chromatography (HPLC) and
microbiological assay. The questions raised by this
investigation are important and worthy of more definitive
answers. (George R. Aronoff, M.D.)
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