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Vancomycin‐Binding Characteristics in Patients with Serious Infections
Author(s) -
Li Li,
Miles Michael V.,
Lakkis Hassan,
Zaritsky Arno L.
Publication year - 1996
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/j.1875-9114.1996.tb03028.x
Subject(s) - vancomycin , medicine , intensive care medicine , staphylococcus aureus , geology , bacteria , paleontology
Study Objective . To examine the extent, variability, and factors affecting vancomycin protein binding. Design . Prospective, open‐label, cohort study. Setting . A general hospital. Patients . Forty‐four adults [mean (± SD) age 50.9 ± 17.1 yrs, range 16.8–92.0 yrs] with serious infections. Interventions . Unbound (V u ) and total (V tot ) vancomycin concentrations were determined by fluorescence polarization immunoassay. A statistical analysis model used the maximum likelihood method to evaluate the association between several important variables and log V u while controlling for log V tot effects. Measurements and Main Results . The mean fraction percentage of unbound vancomycin was 79.5 ± 6.0% (range 53.0–96.3%). While controlling for V tot the total variability of V u was 8.3%, suggesting that vancomycin binding is relatively constant in sick adults. We were able to demonstrate a significant statistical interaction effect between gender and globulin protein concentration on V u (p = 0.022). Globulin protein concentration in men was negatively associated with V u (p = 0.0009), but there was no association in women (p = 0.645). Age, race, peak‐trough association, serum creatinine, serum albumin, serum prealbumin, and hemodialysis were not significantly associated with log V u in the statistical model. Conclusion . Compared with earlier studies in healthy adults, vancomycin binding appears to be decreased during acute illness, and intrapatient and interpatient variability are relatively small. Unbound vancomycin concentration appears to be gender dependent.