C3.1 R4(e): Perform & document a vancomycin or aminoglycoside pharmacokinetic interpretation

Patient’s Vancomycin Doses:

Dose # of Doses Prior to Level Level
1g IV Q12H 5 24.3 (High)
750mg IV Q24H 2 15.3
  • Aspirate from L shoulder: MRSA +
  • Challenging to obtain information from patient (e.g. wasn’t able to ask about side effects like sxs of ototoxicity). Patient is mostly in bed, but appears to be improving.


Clinical Pharmacy Note: Re: Vancomycin

s/0 77 yo male with MRSA septic arthritis L shoulder. Target vanco should be: 15-20mg/L.

vanco to 750mg Q24H since Jun 19. Vanco level at 2147 on Jun 21: 15.3 mg/L

eGFR~ 89, stable for last few days.
Jun 21 – WBC: 10.3, CRPH 57.7 ↑
Jun 22 – 36.8oC T, BP 130/87, HR 87

Pain was worse last night (pt crying), as per nurse. Settled with PRN hydromorphone dose. No complaints of pain today. Swelling same as yesterday, as per nurse.


  1. Septic arthritis appropriately treated with vancomycin for MRSA.
  2. Level is drawn appropriately at steady state and is within target.
  3. Renal function stable
  4. All doses charted as given.


  1. Continue vancomycin 750mg IV Q24H
  2. Awaiting ID consult to determine duration of tx.
  3. If prolonged duration, weekly vanco level
  4. Monitor renal function 3 times a week.
  5. Monitor s/s of septic arthritis (pain, swelling, mobility), WBC, CRPH, vital signs. If clinically worsening, increase vanco monitoring and R/A.


  • Continue vancomycin IV with no stop date. Awaiting ID consult RE: duration of treatment.

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