Question

Which patient should receive vancomycin dosed by levels?

A. A 34-year old male who is being treated for bacterial meningitis 3 days after a craniotomy

B. A 65-year old in the ICU with multiorgan failure secondary to Staphylococcal sepsis

C. A 75-year old female with osteomyelitis secondary to GBS

D. A 19-year old with methicillin-resistant Staphylococcus aureus bacteremia and a vancomycin trough of <5 mcg/mL

Answer 1

B. 65-year old in the ICU with multiorgan failure secondary to Staphylococcal sepsis

Vancomycin is not absorbed orally. After i.v. administration, it is widely distributed, penetrates serous cavities, inflamed meninges and is excreted mainly unchanged by glomerular filtration with a t½ of 6 hour

Total body clearance is thus dependent on the kidney, and is correlated with glomerular filtration rate and creatinine clearance.

Elimination of vancomycin is slowed in patients with renal insufficiency.

Accumulation of vancomycin may thus occur and may lead to toxic side effects if the dosage is not modified in accordance with the degree of renal failure.