Therapeutic Drug Monitoring of Vancomycin in an Adult Patient with Augmented Renal Clearance - A Case Report

Background: Augmented renal clearance (ARC) significantly affects the pharmacokinetics (PK)/ pharmacodynamics (PD) of vancomycin, causing sub-therapeutic serum concentrations and thus leading to treatment failure and bacterial drug resistance.Therapeutic Drug Monitoring (TDM) is important to ensure adequate therapeutic exposure of vancomycin and to minimize the risk of toxicity.A 29-year-old gentleman was admitted to the Intensive Care Unit (ICU) and was diagnosed with Corynebacterium striatum bacteremia.Intravenous (IV) vancomycin 1.75g stat and 1g BD was started on this patient who showed ARC (CrCl >130 ml/min) prior to and during treatment with IV vancomycin.The vancomycin trough level (C trough ) was successfully increased to the therapeutic range (15-20 mcg/mL) following dosage adjustment based on Therapeutic Drug Monitoring (TDM).Conclusion: Increasing dosing frequency, prolonged infusion time and frequent TDM can be utilized as a strategy to achieve therapeutic trough levels (C trough ) of vancomycin in patients with augmented renal clearance (ARC).The estimated half-life may serve as a valuable parameter for optimizing therapeutic regimens; further research is necessary to validate this hypothesis.