Table III.

Advantages and Limitations of Different Media for Determining the Antimicrobial Activity of Protein-Bound Antibiotics In Vitro

		Advantages	Limitations	References
MHB with the calculated protein-free concentration of an antibiotic	MHB is a liquid medium used for antibiotic susceptibility studies	No impairment of bacterial growth	Absence of proteins	9,47,48,53,54
		Good overall comparability of results (widely used)	Does not account for reversible PB
			Does not account for differences of influence of PB for gram-negative/gram-positive bacteria
MHB with serum	Human serum is admixed to test medium at different concentrations (ranging from 20% to 100% serum)	Mimicry of in vivo conditions (including pH)	Intrinsic antibacterial effect of serum hampers bacterial growth	7,50,52,55–65
		PB capacity of 100% serum approximates PB capacity of whole blood	Variety of serum content by different investigators
			Relatively high costs and limited availability of human serum
MHB with albumin	Albumin is admixed to broth (e.g. MHB) at a concentration of 4 g/dL	Absence of intrinsic antibacterial effect	Absence of serum proteins other than albumin	7,9,47,49,66,67
		Bacterial growth equal to pure MHB	Limited PB capacity, compared to serum
			Relatively high costs of human albumin
			PB capacity dependent on presence of ions like Ca++

MHB Müller Hinton Broth