A 62-year-old woman with a history of type 2 diabetes mellitus and a methicillin-resistant Staphylococcus aureus skin and soft tissue infection of the right lower extremity is prescribed vancomycin 1 g IV every 12 hours. Her baseline serum creatinine is 0.8 mg/dL, and her weight is 68 kg. On admission, her temperature is 38.2°C, blood pressure is 128/76 mmHg, heart rate is 92/min, and urinalysis is unremarkable. At day 5 of therapy, she reports decreased urine output, her serum creatinine has risen to 1.6 mg/dL, blood urea nitrogen is 28 mg/dL, and her vancomycin trough level is 24 μg/mL. Which of the following is the most appropriate next step?
- A)Add hydration and diuretics to promote vancomycin clearance
- B)Continue current dosing; vancomycin-induced renal injury is always reversible
- C)Increase vancomycin dose to achieve trough levels >25 μg/mL
- D)Switch to gentamicin, which has less nephrotoxicity
- E)Reduce vancomycin dose and frequency due to declining renal functionGABARITO
Explicação
Vancomycin is nephrotoxic, particularly at higher trough levels (>20 μg/mL), with underlying renal disease, or when combined with other nephrotoxins. This patient has vancomycin-induced acute kidney injury. Dosing must be adjusted based on renal function and t... Ver explicação completa e trilha adaptativa →