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Vancomycin protein binding in patients with infections caused by Staphylococcus aureus
L M Albrecht1, M J Rybak, L H Warbasse
1Wayne State University, Detroit, MI.
DICP : the Annals of Pharmacotherapy
|July 1, 1991
Summary
Vancomycin protein binding varies significantly, influenced by serum albumin levels. While changes occur, the clinical impact on vancomycin therapy may be minimal.
Area of Science:
- Pharmacology
- Clinical Chemistry
Background:
- Vancomycin protein binding is highly variable, impacting drug efficacy.
- Understanding binding is crucial for optimizing vancomycin dosing in patients with Staphylococcus aureus infections.
Purpose of the Study:
- To investigate the unbound fraction of vancomycin in patients with Staphylococcus aureus infections.
- To determine the correlation between vancomycin binding and patient factors like serum albumin and renal function.
Main Methods:
- Serial blood sampling from 34 patients (intravenous drug abusers, burn patients, controls) over 8-12 hour intervals.
- In vitro studies using albumin solutions.
- Ultrafiltration and fluorescence polarization immunoassay to analyze vancomycin concentrations.
Main Results:
- The unbound fraction of vancomycin ranged from 0.41 to 0.77 (mean 0.54 ± 0.08).
- Unbound fraction significantly correlated with serum albumin (r = -0.344, p < 0.046) and renal clearance (r = 0.394, p < 0.021).
- In vitro data confirmed the association between albumin concentration and unbound fraction (r = -0.94, p < 0.017).
Conclusions:
- Vancomycin protein binding is influenced by serum albumin concentration.
- Despite observed correlations, the clinical significance of these vancomycin binding changes may be limited.