Quinolones and false-positive urine screening for opiates by immunoassay technology.
2001
ContextMillions of assays are performed each year to monitor for substance
abuse in various settings. When common medications cross-react with frequently
used testing assays, false-positive results can lead to invalid conclusions.ObjectiveTo evaluate cross-reactivity of quinolone antimicrobials in common opiate
screening assays and to assess the in vivo implications of this phenomenon.Design, Setting, and ParticipantsThe reactivity of 13 quinolones (levofloxacin, ofloxacin, pefloxacin,
enoxacin, moxifloxacin, gatifloxacin, trovafloxacin, sparfloxacin, lomefloxacin,
ciprofloxacin, clinafloxacin, norfloxacin, and nalidixic acid) was tested
in 5 commercial opiate screening assays from September 1998 to March 1999.
In 6 healthy volunteers, we confirmed the cross-reactivity of levofloxacin
or ofloxacin with these opiate screening assays.Main Outcome MeasureOpiate assay activity (threshold for positive result, 300 ng/mL of morphine).ResultsNine of the quinolones caused assay results above the threshold for
a positive result in at least 1 of the assays. Four of the assay systems caused
false-positive results for at least 1 quinolone. Eleven of the 13 compounds
caused some opiate activity by at least 1 assay system. At least 1 compound
caused opiate assay activity in all 5 assay systems.
Levofloxacin, ofloxacin,
and pefloxacin were most likely to lead to a false-positive opiate result.
Positive results were obtained in urine from all 6 volunteers.ConclusionGreater attention to the cross-reactivity of quinolones with immunoassays
for opiates is needed to minimize the potential for invalid test interpretation.
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