ICU Vivas · Applied pharmacology
Data viva — the drug levels and the TDM
A data viva on antibiotic TDM — the vancomycin AUC, the aminoglycoside peak, the beta-lactam trough, and dose adjustment for augmented clearance.
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CICMFFICMEDIC
Prompt
The drug levels from an ICU patient on multiple infusions, to be interpreted.
Stimulus
You are shown the drug levels from a 30-year-old trauma patient (measured urinary creatinine clearance 150 mL/min) on vancomycin, meropenem and gentamicin:
| Drug | Level | Target |
|---|---|---|
| Vancomycin AUC24 | 310 | (400-600) |
| Meropenem trough | 1.2 mg/L | (above MIC; severe infection: trough at 4x MIC) |
| Gentamicin peak | 4 mg/L | (peak/MIC 8-10: fixed 7 mg/kg once-daily program) |
Interpret and adjust.[1]
References4ShowHide
- [1]Rybak MJ, Le J, et al. Executive Summary: Therapeutic Monitoring of Vancomycin for Serious Methicillin-Resistant Staphylococcus aureus Infections Pharmacotherapy, 2020.PMID 32227354
- [2]Roberts JA, Paul SK, et al. DALI: defining antibiotic levels in intensive care unit patients Clin Infect Dis, 2014.PMID 24429437
- [3]Bilbao-Meseguer I, Rodriguez-Gascon A, et al. Augmented Renal Clearance in Critically Ill Patients: A Systematic Review Clin Pharmacokinet, 2018.PMID 29441476
- [4]Nicolau DP, Freeman CD, et al. Experience with a once-daily aminoglycoside program administered to 2,184 adult patients Antimicrob Agents Chemother, 1995.PMID 7793867