Abstract
Background
Increased creatinine clearance and subsequent elevated antimicrobial clearance is evident in many traumatic brain injury (TBI) patients due to augmented renal clearance (ARC). Little is known about the effects of ARC on other renally-eliminated medications, such as the anti-epileptic drug levetiracetam.
Methods
This is a case report of serum monitoring of vancomycin and levetiracetam in a 22 year old female with ARC after severe TBI.
Results
The patient exhibited ARC of vancomycin as evidenced by her low serum concentrations with standard vancomycin dosing. Her estimated creatinine clearance based on vancomycin clearance was 243.9 ml/min. Serum concentrations also suggested ARC of levetiracetam. No toxicities for either medication were noted, even after dose adjustment to account for possible ARC.
Conclusions
Vancomycin and levetiracetam both appear to be subject to ARC after TBI. Clinicians should be mindful that standard dosing of these agents may not achieve typical target concentrations in this clinical scenario.
References
Udy A, Boots R, Senthuran S, et al. Augmented creatinine clearance in traumatic brain injury. Anesth Analg. 2010;111:1505–10.
Udy AA, Roberts JA, Boots RJ, Paterson DL, Lipman J. Augmented renal clearance: implications for antibacterial dosing in the critically ill. Clin Pharmacokinet. 2010;49:1–16.
Udy AA, Roberts JA, Lipman J. Implications of augmented renal clearance in critically ill patients. Nat Rev Nephrol. 2011;7:539–43.
Udy AA, Putt MT, Shanmugathasan S, Roberts JA, Lipman J. Augmented renal clearance in the intensive care unit: an illustrative case series. Int J Antimicrob Agents. 2010;35:606–8.
Udy AA, Varghese JM, Altukroni M, et al. Subtherapeutic initial beta-lactam concentrations in select critically ill patients creatinine clearance and 03B2-lactams: association between augmented renal clearance and low trough drug concentrations. Chest. 2012;142:30–9.
DuBois D, BuBois EF. A formula to estimate the approximate surface area if height and weight be known. Arch Intern Med. 1916;17:863–71.
Clinical pharmacokinetics service and anticoagulation guidelines. 2010. http://www.hosp.uky.edu/pharmacy/formulary/criteria/Clinical_PKS_Manual-July_2010.pdf. Accessed 11 Mar 2013.
Eisenberg HM, Frankowski RF, Contant CF, Marshall LF, Walker MD. High-dose barbiturate control of elevated intracranial pressure in patients with severe head injury. J Neurosurg. 1988;69:15–23.
Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16:31–41.
Levey AS, Coresh J, Greene T, et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006;145:247–54.
Matzke GR, McGory RW, Halstenson CE, Keane WF. Pharmacokinetics of vancomycin in patients with various degrees of renal function. Antimicrob Agents Chemother. 1984;25:433–7.
Zaske DE, Sawchuk RJ, Gerding DN, Strate RG. Increased dosage requirements of gentamicin in burn patients. J Trauma. 1976;16:824–8.
Strolin Benedetti M, Whomsley R, Nicolas JM, Young C, Baltes E. Pharmacokinetics and metabolism of 14C-levetiracetam, a new antiepileptic agent, in healthy volunteers. Eur J Clin Pharmacol. 2003;59:621–30.
Fay MA, Sheth RD, Gidal BE. Oral absorption kinetics of levetiracetam: the effect of mixing with food or enteral nutrition formulas. Clin Ther. 2005;27:594–8.
Patsalos PN. Clinical pharmacokinetics of levetiracetam. Clin Pharmacokinet. 2004;43:707–24.
Rybak MJ, Lomaestro BM, Rotschafer JC, et al. Vancomycin therapeutic guidelines: a summary of consensus recommendations from the infectious diseases Society of America, the American Society of Health-System Pharmacists, and the Society of Infectious Diseases Pharmacists. Clin Infect Dis. 2009;49:325–7.
Klein P, Herr D, Pearl PL, et al. Results of phase II pharmacokinetic study of levetiracetam for prevention of post-traumatic epilepsy. Epilepsy behav. 2012;24:457–61.
Jones KE, Puccio AM, Harshman KJ, et al. Levetiracetam versus phenytoin for seizure prophylaxis in severe traumatic brain injury. Neurosurg Focus. 2008;25:E3.
Szaflarski JP, Sangha KS, Lindsell CJ, Shutter LA. Prospective, randomized, single-blinded comparative trial of intravenous levetiracetam versus phenytoin for seizure prophylaxis. Neurocrit Care. 2009;12:165–72.
Brain Trauma Foundation. Management of severe traumatic brain injury. J Neurotrauma. 2007;24:S1–95.
Rybak MJ, Albrecht LM, Berman JR, Warbasse LH, Svensson CK. Vancomycin pharmacokinetics in burn patients and intravenous drug abusers. Antimicrob Agents Chemother. 1990;34:792–5.
Baptista JP, Udy AA, Sousa E, et al. A comparison of estimates of glomerular filtration in critically ill patients with augmented renal clearance. Crit Care. 2011;15:R139.
Herrera-Gutierrez ME, Seller-Perez G, Banderas-Bravo E, Munoz-Bono J, Lebron-Gallardo M, Fernandez-Ortega JF. Replacement of 24-h creatinine clearance by 2-h creatinine clearance in intensive care unit patients: a single-center study. Intensive Care Med. 2007;33:1900–6.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cook, A.M., Arora, S., Davis, J. et al. Augmented Renal Clearance of Vancomycin and Levetiracetam in a Traumatic Brain Injury Patient. Neurocrit Care 19, 210–214 (2013). https://doi.org/10.1007/s12028-013-9837-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12028-013-9837-y