Use Of Vancomycin

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Use of Vancomycin

BA, a 72year old male, is admitted to the inpatient department for intravenous antibiotics, wound debridement, and management of his right great toe. He has past cellulitis ulcers, complicated with wound culture positive for MRSA

The subjective data: patient reports stepping on an exposed carpet tack while walking two months ago at his home, which caused a cut at his right toe .he reports the area has never healed fully, and the wound seems to be getting bigger. He reports an increased redness and fowl whitish-yellow discharge on his socks over the past week. He complains of fever, chills, and sweats over the past several days. He has been using ibuprofen for the pain without any relief. The patient often reports not self-monitoring his blood glucose levels at home. He also confirms no known allergies.

In the systematic review, he denies weight loss, weakness, or fatigue. Concerning the HEENT system, he denies visual changes or loss and no signs of upper respiratory tract infection. He denies chest pain, discomfort, and pressure on cardiovascular system review. Respiratory wise, no signs of DIB or lower respiratory tract infection

Objective data

No distress was noted on observation .patient can communicate and comprehend verbal instructions. Vitally, the patient is stable with a pulse rate of 93b.p.m, respiratory rate of 19b.p.m and blood pressure 130/70mm/hg, and temperature of 101f.he has a weight of 152lbs.on auscultation, there is scattered expiratory wheezes s1 and s2 of the heard records regular rate and rhythm. On palpation, the abdomen is soft and non-tender. Bowel sounds were noted four times. The extremities are bilateral with one pitting edema. There was a 3cm necrotic concentric wound on the plantar surface of the right hallux, first metatarsal head. Local wound symptoms were noted, including cellulitis. Black Escher noted around edges with a soft yellow appearance towards the center of the wound. The wound produces a moderate amount of creamy yellow purulent exudate.

An x-ray of the right foot indicates minimal soft tissue swelling on the dorsum of the foot. Question of mild cortical irregularity at first MTP joint. more investigations to be done. An MRI done confirms osteo edema and osteomyelitis the lab works doesn’t indicate signs of AKIThe goal of treatment on the osteomyelitis is to complete eradication of infection while preserving the soft tissue, healing the bone segment, and preserving the length function of the limb

Assessment

A: IBW(ideal body weight)

Patient height 5feet 8inches

IBW=50+2.3(each inch over 5feet)

=50+2.3(8)

=50+18.4

=68.4kgs

B: choice of body weight this is the adjusted body weight

ADJBW=IBW+0.4*(ABW-IBW)

ABW=152Pounds

1pound=0.454

152pounds=?

125*0.454/1

69.008kgs

ADJBW=68.4+0.4*(69.008-68.4)

=68.4+0.4*(0.608)

=68.4+0.2432

=68.6432Kgs

C: creatinine clearance(CrCl)

CrCl=[114-(0.8*age)]/creatinine level In mg/dl

=[114-(0.8*72)]/1.4

=[114-57.6]/1.4

=56.4/1.4

=40.29

D:ke

=0.00083*CrCl+0.0044

=0.00083*40.29+0.0044

=0.0334+0.0044

=0.0378

E:half life(T1/2)

=0.693/Ke

=0.693/0.0378

=18.3333

F_Tau=6*{72/[(10*cl)+1.9]}

CL=(CrCl*0.0075)+0.004

=(40.29*0.0075)+0.004

=0.3022+0.04

CL=0.3422

Tau=6*{72/[(10*0.3422)+1.9]}

=6*{72/[3.422+1.9]

=6*{72/5.322}

=6*13.5287

=81.1722

G: loading dose

a) standard loading dose

25-30mg/kg

=25*69.008

=1725.2mgs

Approximately 2000mgs

30*69.008

=2070.24mgs

Approximately 2250mgs

b) modified loading dose

Applies when CrCl is less than 30 and no signs of AKI, plus the patient shouldn’t be on CRRT

20-25mg/kg

=20*69.008

=1380.16mgs

Approximately 1500mgs

25*69.008

=1725.2

Approximately 2000mgs

H: maintenance dose

For CrCl of (30-50), dose of 10-15mg/kg

10*69.008

=690.08mg

Approximately 1000mgs

Or

15*69.008

=1035.12mgs

Approximately 1250mgs

I: expected trough and peak concentrations for maintenance doses

The expected peak is an hour after the 3rd dose

The expected trough is 30mins before 3rd dose

It is within the standard rate of infusion, which is two to three doses in 24hours, where one gram runs over 60mins. The duration of treatment is 7 to 21days. The standard infusion rate is important to prevent erythematous rash on the upper body and face. Vancomycin should be administered intravenously due to its low oral bioavailability. Close monitoring is key in vancomycin to avoid nephrotoxicity