Vancomycin anaphylaxis and successful desensitization in a patient with end stage renal disease on hemodialysis by maintaining steady antibiotic levels

Background: Vancomycin anaphylaxis is a major management problem in patient s with methicillin-resistant Staphylococcus aureus (MRSA) sepsis, Lerner et al in 1984 have described a protocol for desensitization to vancomycin; ho wever, antibiotic blood levels have never been used as a guide in this proc ess. Case Report: A 46-year-old female with ESRD on hemodialysis who developed a dialysis-catheter related MRSA sepsis was found to have anaphylaxis to van comycin. She underwent successful desensitization to vancomycin using Lerne r's protocol, Periodic antibiotic blood levels were used to guide the amoun t and frequency of vancomycin infusion to successfully maintain desensitiza tion thereafter. Discussion: Lerner described loss of desensitization to vancomycin when ant ibiotic infusion was stopped after 18 hours followed by successful desensit ization to the same drug via the same protocol. This observation points out that desensitization to vancomycin appears to be dependent on some minimal drug level, In our case report, we have for the first time used the concep t of blood levels to maintain successful desensitization to an antibiotic. Conclusion: We hypothesize that desensitization to vancomycin can be induce d and maintained by keeping a minimum antibiotic blood level. Further studi es are needed to quantify this.