Vancomycin Administration

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Vancomycin administration

BA is a 66year female admitted to the inpatient department for intravenous antibiotics, wound debridement, and management of his right great toe. She has past cellulitis ulcers, which complicated with wound culture positive for MRSA

The subjective data:

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

She denies weight loss, weakness, or fatigue on a systematic review. Regarding the HEENT system, she denies visual loss or changes, and no signs of upper respiratory tract infection are reported. She denies chest pain, discomfort, and pressure on the cardiovascular system review. Respiratory-wise, no signs of DIB or lower respiratory tract infection. She is a known diabetic and hypertensive patient taking lisinopril 5mg once a day and metformin 850mg twice a day.

Socially, she is a retired teacher who lives with her husband. She quit smoking 32years ago and denies consuming alcohol. she is very active in the community and would like to resume her driving after going back to her volunteer work

Objective data

No distress was noted on observation. The patient is communicating and comprehending verbal instructions. On taking vitals, the patient is stable with a temperature of 101f, pulse rate of 93b.p.m, respiratory rate of 19b.p.m, and blood pressure of 123/70mm/hg. She weighs 13Olbs. On auscultation, there are scattered expiratory wheezes. s1 and s2 of the heart record 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. 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 shows minimal soft tissue swelling on the dorsum of the foot. Question of mild cortical irregularity at first MTP joint .more investigations are pending to confirm the diagnosis. An MRI done confirms osteo edema and osteomyelitis. Concerning the lab works, no indication of signs of AKI. The goal of treatment on osteomyelitis is to eradicate the 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 3inches

IBW=45.5+2.3(each inch over 5feet)

=45.5+2.3(3)

=45.5+6.9

=52.4kgs

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

ADJBW=IBW+0.4*(ABW-IBW)

ABW=130Pounds

1pound=0.454

130pounds=?

130*0.454/1

=59.02kgs

ADJBW=52.4+0.4*(59.02-52.4)

=52.4+0.4*(6.62)

=52.4+2.648

=55.048

C: creatinine clearance(CrCl)

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

=[114-(0.8*66)]/1.9

=[114-52.8]/1.9

=61.2/1.9

=32.21

D:ke

=0.00083*CrCl+0.0044

=0.00083*32.21+0.0044

=0.0267+0.0044

=0.0311

E:half life(T1/2)

=0.693/Ke=0.693/0.0311

=22.28

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

CL=(CrCl*0.0075)+0.004

=(32.21*0.0075)+0.004

=0.2416+0.04

CL=0.2816

Tau=6*{72/[(10*0.2816)+1.9]}

=6*{72/[2.816+1.9]

=6*{72/4.716}

=6*15.2672

=91.6032

G: loading dose

a) standard loading dose

25-30mg/kg

=25*52.4

=1310mgs

Approximately 1500mgs

30*52.4

=1572

Approximately 1750mgs

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*52.4

=1048mgs

Approximately 1250mgs

25*52.4

=1310mgs

Approximately 1500mgs

H: maintenance dose

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

10*52.4

=524mgs

Approximately 750mgs

Or

15*52.4

=786

Approximately 1000mgs

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

The infusion rate is two to three doses daily within the standard rate. One gram runs over 60mins. The standard infusion rate is important to prevent erythematous rash on the upper body and face. Vancomycin is intravenous as it has low oral bioavailability. Treatment is given for a period between 7 days and 21 days. Vancomycin causes nephrotoxicity; hence close monitoring is essential.