Higher than standard meropenem and linezolid dosages needed for appropriate treatment of an intracerebral hemorrhage patient with augmented renal clearance
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A 57-year-old, 49 kg female was admitted at the Emergency Department after severe intracerebral hemorrhage. Head CT-scan revealed rupture of a saccular aneurysm of the right middle cerebral artery. External ventricular drain (EVD) was placed in the right lateral ventricle to treat hydrocephalus, and endovascular coiling of the cerebral aneurysm was performed.
On day 3, an EVD-related infection was suspected [C-reactive protein (C-RP) of 82.56 mg/L, normal range 0–5 mg/L; and pro-calcitonin (PCT) of 0.87 ng/mL, normal range < 0.10 ng/mL], and empirical antimicrobial therapy was started intravenously with cefotaxime 2 g q8h. On day 8, C-RP was 110.03 mg/L, and antimicrobial therapy was escalated to meropenem [500 mg q6h over 6 h (i.e., by continuous infusion, CI) after 2 g loading] plus linezolid (600 mg q12h intravenously).
Despite escalated therapy, C-RP increased furtherly and peaked on day 13 (241.47 mg/L). Therapeutic drug monitoring (TDM) was performed for assessing drug exposure...
W. H. holds or has recently held research grants with F2G, AiCuris, Astellas Pharma, Spero Therapeutics, Matinas Biosciences, Antabio, Amplyx, Allecra, Auspherix and Pfizer and he holds awards from the National Institutes of Health, Medical Research Council, National Institute of Health Research, FDA and the European Commission (FP7 and IMI). W. H. acted as a consultant for F2G, Amplyx, Ausperix, Spero Therapeutics, Medicines Company, Gilead and Basilea in the past 3 years, and he is an Ordinary Council Member for the British Society of Antimicrobial Chemotherapy. F.P. acted as consultants for, and have been on the speakers’ bureau of Angelini, Basilea, Gilead, MSD, Nordic Pharma and Pfizer in the previous 3 years. P.G.C., C.B and A.D.M. had no financial relationships with any organizations that might have an interest in the submitted work.
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