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Updated: May 9, 2026

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Multicomponent antibiotic substances produced by fermentation: implications for regulatory authorities, critically
Adrian J Brink1, Guy A Richards2, Gaia Colombo3
1Department of Clinical Microbiology, Ampath National Laboratory Services, Suite 9C, Milpark Hospital, 9 Guild Road, Parktown West, 2193 Johannesburg, South Africa.
Abstract:
Teicoplanin and polymyxin E (colistin) are antibiotics consisting of multiple, closely related subcomponents, produced by fermentation. The principal components comprise a complex mixture of chemically related, active substances (teicoplanin A(2-1)-A(2-5) and polymyxin E(1-2), respectively), which might be required to be present in specific ratios to ensure optimal antibacterial and clinical efficacy. These subcomponents differ in their fatty acid and amino acid composition and, as such, the lipophilic and protein binding characteristics differ between components. This has therapeutic implications for critically ill patients, as the volume of distribution of the teicoplanin A2 and polymyxin E analogues at the onset of an intravenous infusion may impact on expected pharmacokinetics and influence outcome.
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