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Case Report: Subtherapeutic Vancomycin and Meropenem Concentrations due to Augmented Renal Clearance in a Patient

Marcus Fransson1, Anders Helldén2, Åse Östholm Balkhed3

  • 1Department of Neurosurgery and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.

Frontiers in Pharmacology
|October 25, 2021
PubMed

Insights

Augmented renal clearance can lead to subtherapeutic antibiotic levels in serious infections. This case highlights the need for higher antibiotic doses to ensure effective treatment in patients with high creatinine clearance.

Area of Science:

  • Infectious Diseases
  • Nephrology
  • Pharmacology

Background:

  • _Streptococcus intermedius_ can cause life-threatening brain abscesses, often originating from dental infections.
  • Spread to the eye and brain requires prompt antibiotic and neurosurgical intervention.
  • This case involves a patient with apical periodontitis, endophthalmitis, and multiple brain abscesses.

Purpose of the Study:

  • To report a case of _Streptococcus intermedius_ brain abscesses with challenging antibiotic treatment.
  • To investigate the impact of augmented renal clearance on antibiotic pharmacokinetics.
  • To discuss the mechanisms of drug transport in critically ill patients.

Main Methods:

  • Case report of a 34-year-old male patient.
  • Treatment with meropenem and vancomycin, with dose adjustments.
  • Assessment of renal function, including creatinine, iohexol, and cystatin C clearance.
  • Monitoring of plasma antibiotic concentrations and renal parameters.

Main Results:

  • Initial antibiotic doses resulted in subtherapeutic concentrations due to augmented renal clearance.
  • Increased doses of meropenem (16 g/day) and vancomycin (1.5 g x 4) achieved adequate levels.
  • Trimethoprim-sulfamethoxazole temporarily altered renal function markers.
  • Increased tubular secretion was identified as the cause of suboptimal drug concentrations.

Conclusions:

  • Augmented renal clearance can compromise antibiotic efficacy in severe infections.
  • Higher antibiotic doses are crucial to achieve therapeutic concentrations in patients with augmented renal clearance.
  • Understanding renal tubular transporter mechanisms is vital for optimizing antibiotic therapy in critically ill patients.
Keywords:
augmented renal clearancecreatinine clearanceglomerular filtration rateiohexol clearancesuboptimal antibiotic treatmenttubular cell membrane transportersurea clearancevancomycin clearance

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