heroin and Thrombophlebitis

A patient with methicillin-resistant Staphylococcus aureus bacteremia received vancomycin (MIC = 0.8 microgram/ml, MBC = 15 micrograms/ml) and heparin simultaneously through the same intravenous line to treat a septic deep venous thrombosis. Bacteremia persisted for 7 days. Bacteremia terminated when the simultaneous infusion of heparin and vancomycin through the same line was stopped. This suggested that an interaction between vancomycin and heparin may have occurred, which resulted in a reduction in vancomycin activity. To test for such an interaction, mixtures of heparin and vancomycin in various concentrations were made and tested for antimicrobial activity against the organisms in the patient. A precipitate formed at the concentrations achieved in the intravenous lines, and when the vancomycin concentrations were measured by bioassay, a 50 to 60% reduction in activity was noted. In contrast, when these solutions were prepared and mixed at microgram concentrations, a precipitate was no longer observed, and antimicrobial activity was not reduced. Heparin appeared to interact unfavorably with vancomycin at the concentrations in the intravenous lines when these drugs were administered simultaneously to patients. This may be the cause of poor therapeutic responses to vancomycin in some patients, especially those infected with tolerant organisms.

Topics: Adult; Drug Combinations; Heparin; Heroin; Humans; Infusions, Parenteral; Male; Sepsis; Staphylococcal Infections; Staphylococcus aureus; Substance-Related Disorders; Thrombophlebitis; Vancomycin

Topics: Acanthosis Nigricans; Acne Vulgaris; Dental Caries; Dermatitis, Contact; Drug Eruptions; Edema; Gangrene; Hepatitis A; Heroin; Humans; Impetigo; Life Style; Pigmentation Disorders; Pruritus; Psychophysiologic Disorders; Purpura; Skin Diseases; Skin Manifestations; Substance-Related Disorders; Thrombophlebitis; Urticaria

Topics: Adult; Arm; Heart Atria; Heart Failure; Heroin; Humans; Injections, Intravenous; Phonocardiography; Substance-Related Disorders; Thrombophlebitis; Tricuspid Valve Insufficiency; Venous Pressure

Topics: Adult; Barbiturates; Female; Foreign Bodies; Heroin; Heroin Dependence; Humans; Injections; Injections, Intra-Articular; Injections, Intramuscular; Injections, Intravenous; Injections, Subcutaneous; Ischemia; Male; Muscles; Opium; Phlebography; Substance-Related Disorders; Surgical Procedures, Operative; Thrombophlebitis

Topics: Adolescent; Adult; Age Factors; Aged; Autopsy; Female; Forensic Medicine; Heroin; History, 20th Century; Humans; Injections; Malaria; Male; Middle Aged; Morphine Dependence; New York City; Pulmonary Edema; Quinine; Racial Groups; Sex Factors; Substance-Related Disorders; Thrombophlebitis; Urban Population

Topics: Abdomen, Acute; Aneurysm, Infected; Contracture; Diagnosis, Differential; Femoral Artery; Gastrointestinal Diseases; Hand; Heart Valve Prosthesis; Heroin; Humans; Inflammation; Injections, Intravenous; Skin Diseases, Infectious; Substance-Related Disorders; Surgical Procedures, Operative; Tetanus; Thrombophlebitis

Topics: Adult; Aneurysm; Aneurysm, Infected; Endocarditis, Bacterial; Female; Heroin; Humans; Hypertension, Pulmonary; Injections, Intravenous; Lung Diseases; Male; Methylphenidate; Middle Aged; Pneumonia; Pneumonia, Aspiration; Pulmonary Edema; Pulmonary Embolism; Radiography; Substance-Related Disorders; Thrombophlebitis; Thrombosis; Tuberculosis, Pulmonary; Vascular Diseases

Topics: Adolescent; Adult; Drug and Narcotic Control; Endocarditis, Bacterial; Female; Heroin; Humans; Hypertension, Pulmonary; Male; Opium; Substance-Related Disorders; Thrombophlebitis; United States