Therapeutic Drug Monitoring Training – Case 1
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1. Question
Questions (1-3) pertain to the following case: A 60-year-old Caucasian female who had a urologic procedure 2 days ago presents to ER with symptoms of flank pain, dysuria, and fever. Urine and blood cultures are drawn immediately, in addition to CBC and urinalysis. Urinalysis is consistent with a possible UTI. The patient’s WBC and absolute neutrophil count are elevated, however, her lactic acid is not. BP is slightly elevated (152/87) and so is her pulse (95). The urologist was consulted and he recommended to start the patient on Gentamicin 10 mg/kg IV Q8H for 7 days for complicated UTI and calls you to monitor her kidney function. Which of the following is the appropriate gentamicin dose for this patient? (Weight 85.5 kg, Height 65 inches, SCr 0.6 mg/dL, eGFR 97 mL/min)
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2. Question
It is day 4 for this patient on gentamicin and she hasn’t been feeling any better. Her WBC and neutrophil counts continue to climb. You review the urine and blood cultures and notice that a report has been generated 2 days ago. Urine culture grew Pseudomonas aeruginosa susceptible to Meropenem, Piperacillin/tazobactam, and Ciprofloxacin, and resistant to gentamicin. What would be the most appropriate intervention?
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