ICU Cases · Antimicrobial therapy
The augmented renal clearance — the subtherapeutic antibiotic
A short case on the augmented renal clearance — the young septic/trauma patient with the high cardiac output clears the beta-lactam faster than the standard dose delivers; the increased dose, the prolonged infusion, and the TDM are the fix.
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Prompt
A 25-year-old trauma patient on day 3 has a creatinine clearance of 160 mL/min. His meropenem trough is subtherapeutic. Discuss the PK/PD and the dose adjustment.
Presentation
A 25-year-old trauma patient, ventilated, on the meropenem 1 g TDS for a VAP. The creatinine clearance is 160 mL/min (the augmented renal clearance from the young age, the trauma, the high cardiac output). The meropenem trough is below the MIC (subtherapeutic).[1]
References2ShowHide
- [1]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
- [2]Marino PL The ICU Book. 4th edition, Lippincott Williams & Wilkins, 2014.