A 67-year-old man with a history of poorly controlled type 2 diabetes and a recently replaced mitral valve presents to the emergency department with a 5-day history of fever, chills, and progressive fatigue. His temperature is 39.4°C, blood pressure is 108/62 mmHg, heart rate is 102 beats/min, and respiratory rate is 18 breaths/min. Physical examination reveals a new holosystolic murmur at the cardiac apex, splinter hemorrhages beneath several fingernails, and mild splenomegaly. Blood cultures drawn on admission grow gram-positive cocci in clusters, and transesophageal echocardiography confirms a 1.2 cm vegetation on the prosthetic mitral valve consistent with bacterial endocarditis. Laboratory values show a serum creatinine of 0.9 mg/dL, total bilirubin of 0.8 mg/dL, and normal hepatic transaminases, indicating intact renal and hepatic function. The treatment team initiates intravenous antibiotic therapy but wants the drug to reach the target plasma concentration as rapidly as possible rather than waiting several half-lives. Which of the following pharmacokinetic adjustments is most appropriate to achieve this goal?

1. A)Switch to a competitive antagonist with higher potency
2. B)Reduce the initial dose to avoid first-pass metabolism
3. C)Decrease the dosing interval to change bioavailability
4. D)Increase the maintenance dose based on clearance
5. E)Increase the loading dose based on volume of distributionGABARITO