An Unusual Case of Low Vancomycin Exposure Despite Extremely High Vancomycin Doses Accompanied by Renal Toxicity: A Grand Round

This grand round describes the case of a patient who received 10 grams (143.5 mg/kg) of vancomycin every 24 hours via continuous infusion, in whom the highest observed level was only 15.4 mg/L. Despite subtherapeutic levels, renal impairment was encountered, which resolved after the discontinuation...

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Bibliographic Details
Published inTherapeutic drug monitoring Vol. 45; no. 2; p. 136
Main Authors van Schip, Anne M, van Diemen, Jeske J K, van Hest, Reinier M, Harris, Vanessa C
Format Journal Article
LanguageEnglish
Published United States 01.04.2023
Subjects
Anti-Bacterial Agents
Humans
Kidney
Kidney Diseases - chemically induced
Kidney Diseases - drug therapy
Teaching Rounds
Vancomycin
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Summary:This grand round describes the case of a patient who received 10 grams (143.5 mg/kg) of vancomycin every 24 hours via continuous infusion, in whom the highest observed level was only 15.4 mg/L. Despite subtherapeutic levels, renal impairment was encountered, which resolved after the discontinuation of vancomycin. Glomerular hyperfiltration was found through nuclear glomerular filtration rate measurement, which likely explains the need for high doses (>6 grams per 24 hours continuous infusion) without reaching therapeutic serum levels.
ISSN:1536-3694
DOI:10.1097/FTD.0000000000001061