Section 3 - Pharmacokinetic software

Vancomycin case studies

Case 1

LH is a 53 y/o female who presents with a post-op abdominal abscess and cellulitis. Complicating factors include diabetes, hypertension, and anemia. She received IV contrast today for an abdominal CT. She has No Known Allergies. Blood and wound cultures have been ordered, no growth to date.
Patient demographics:
• Wt = 92 kg
• Ht = 168 cm

Pertinant labs:
• SrCr = 0.57 mg/dl
• WBC 11.5, Segs 83%
• Serum albumin 3.4.

Enter the patient data into Kinetics and determine a Vancomycin treatment plan. Consider:

• What is the target trough for cellulitis?
• Which model should be used considering the patient's BMI?

After 2 days of the above therapy (4 doses), the patient has improved clinically. Culture of the wound drainage shows MRSA sensitive to Vancomycin. A trough level is drawn 30 minutes before the start of the 60 minute infusion. The trough level is reported as 15.7 mcg/ml.

Enter the serum level data into Kinetics and determine a new Vancomycin treatment plan.

Case 2

WB is a 54 y/o male who presents with sepsis due to necrotizing fasciitis. He is allergic to penicillin (anaphylactoid rxn). Complicating factors include diabetes. Blood cultures have been ordered, no growth to date.
Patient demographics:
• Wt = 98 kg
• Ht = 172 cm

Pertinant labs:
• SrCr = 1.03 mg/dl
• WBC 16.1, Segs 87%
• Serum albumin 1.9.

Enter the patient data into Kinetics and determine a Vancomycin treatment plan. Again, consider:

• What is the target trough for sepsis?
• Which model should be used considering the patient's BMI?

After 2 days of the above therapy (4 doses), the patient has improved clinically. SrCr has improved, now 0.76. Preliminary blood culture shows gram positive cocci in clusters. A trough level is drawn 30 minutes before the start of the 90 minute infusion. The trough level is reported as 14.3 mcg/ml.

Enter the serum level data into Kinetics and determine a new Vancomycin treatment plan.

Case 3

RE is a 45 y/o male who presents with extensive cellulitis of the right buttock, having failed outpatient therapy with oral clindamycin. He is allergic to penicillin (hives). Complicating factors include diabetes and hypertension. Preliminary result from culture of wound drainage is gram positive cocci in clusters.
Patient demographics:
• Wt = 87 kg
• Ht = 179 cm

Pertinant labs:
• SrCr = 0.92 mg/dl
• WBC 16.2, Segs 81%
• Serum albumin 3.4.

Enter the patient data into Kinetics and determine a Vancomycin treatment plan. Again, consider:

• What is the target trough for cellulitis?
• Which model should be used considering the patient's BMI?

After 2 days of the above therapy (3 doses) the trough level is 12.4, same dose was continued. After 7 days of therapy (13 doses), the trough has increased to 16.4. SrCr has remained low, now 0.61.

Enter the serum level data into Kinetics and determine a new Vancomycin treatment plan.

A complex case

Click here to read an interesting vancomycin case.

Section 3 - Pharmacokinetic software