University of Kentucky Pharmacy Services, Lexington, KY, USA,
Neurocrit Care. 2013 Oct;19(2):210-4. doi: 10.1007/s12028-013-9837-y.
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.
This is a case report of serum monitoring of vancomycin and levetiracetam in a 22 year old female with ARC after severe TBI.
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.
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.
由于肾脏清除率增加（ARC），许多创伤性脑损伤（TBI）患者的肌酐清除率增加，随后抗菌药物清除率也升高。对于 ARC 对其他肾脏消除药物的影响，例如抗癫痫药物左乙拉西坦，了解甚少。
这是一例严重 TBI 后出现 ARC 的 22 岁女性患者的万古霉素和左乙拉西坦血清监测的病例报告。
患者的万古霉素血清浓度较低，表明存在 ARC，而万古霉素的标准剂量表明其 ARC。根据万古霉素清除率估计的肌酐清除率为 243.9 ml/min。左乙拉西坦的血清浓度也表明存在 ARC。即使在考虑可能的 ARC 后调整剂量，也未发现两种药物的毒性。
TBI 后，万古霉素和左乙拉西坦似乎都受到 ARC 的影响。临床医生应注意，在这种临床情况下，这些药物的标准剂量可能无法达到典型的目标浓度。
