title: Augmented renal clearance of vancomycin and levetiracetam in a traumatic brain injury patient.
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.
authors.affiliation: University of Kentucky Pharmacy Services, Lexington, KY, USA, amcook0@email.uky.edu.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Cook
authors.forename: Shaily
authors.initials: S
authors.lastname: Arora
authors.forename: Justin
authors.initials: J
authors.lastname: Davis
authors.forename: Thomas
authors.initials: T
authors.lastname: Pittman
mesh_terms: D000900:Anti-Bacterial Agents / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use; D000927:Anticonvulsants / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control; D001930:Brain Injuries / Q000150:complications / Q000188:drug therapy*; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D007668:Kidney / Q000502:physiology; D000077287:Levetiracetam; D010889:Piracetam / Q000031:analogs & derivatives* / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use; D012640:Seizures / Q000209:etiology / Q000517:prevention & control; D014556:Urine; D014640:Vancomycin / Q000097:blood / Q000493:pharmacokinetics* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000927:Anticonvulsants; D000077287:Levetiracetam; D014640:Vancomycin; D010889:Piracetam
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