JM is a 50-year-old, 70-kg (5 ft 10 in) male with gram-negative pneumonia.

His current
serum creatinine is 0.9 mg/dL, and it has been stable over the last 5 days since admission. A
gentamicin dose of 170 mg every 8 hours was prescribed and expected to achieve steady-state
peak and trough concentrations equal to 9 μg/mL and 1 μg/mL, respectively. After the third
dose, steady-state peak and trough concentrations were measured and were 12 μg/mL and 1.4
μg/mL, respectively. Calculate a new gentamicin dose that would provide a steady-state peak
of 9 μg/mL.

1. Estimate creatinine clearance.

2. Estimate elimination rate constant (ke) and half-life (t1/2).
3. Compute new dose to achieve desired serum concentration.
4. Check steady-state trough concentration for new dosage regimen.

ZW is a 35-year-old, 150-kg (5 ft 5 in) female with an intraabdominal infection. Her current

serum creatinine is 1.1 mg/dL and is stable. A tobramycin dose of 165 mg every 8 hours was
prescribed and expected to achieve steady-state peak and trough concentrations equal to 6
μg/mL and 0.5 μg/mL, respectively. After the fifth dose, steady-state peak and trough
concentrations were measured and were 4 μg/mL and <0.5 μg/mL (e.g., below assay limits),
respectively. Calculate a new tobramycin dose that would provide a steady-state peak of 6
μg/mL.
1. Estimate creatinine clearance.
2. Estimate elimination rate constant (ke) and half-life (t1/2).
3. Compute new dose to achieve desired serum concentration.
4. Check steady-state trough concentration for new dosage regimen.
An 87-y-old Japanese woman was admitted to our hospital on suspicion of infectious endocarditis.
Administration of tazobactam/piperacillin was immediately started after hospitalization. The
diagnosis of endocarditis was established by echocardiography. On day 2 of admission, the patient ’
s C-reactive protein level was 26.22 mg/dl (normal, 0.2 mg/dl), white blood cell count (WBC) was
24.2 10 9/l (3.5 – 8.5 10 9/l), procalcitonin (PCT) was 39.8 ng/ml (normal, 0.00 – 0.50 ng/ml),
blood urea nitrogen (BUN) was 52 mg/dl (normal, 8 – 22 mg/dl), serum creatinine (SCr) was 5.03
mg/dl (normal, 0.40 – 0.70 mg/dl), aspartate aminotransferase (AST) was 19 IU/l (normal, 13 – 33
IU/l), and alanine aminotransferase (ALT) was 13 IU/l (normal, 8 – 42 IU/l). MRSA was detected by
blood culture of the venous blood, confi rming the diagnosis of infectious endocarditis. The patient
was treated with a combined therapy of vancomycin and gentamicin. The administration of
vancomycin was started on day 8, and gentamicin was started on day 13. During her hospital stay,
the patient tolerated haemodialysis 3 times/week for 3 h without complications. Improvements in
WBC and PCT were observed 2 days after initiating the combined gentamicin and vancomycin
therapy. No changes in AST, ALT, BUN, or SCr during the combined therapy period were observed,
and MRSA was not detected by blood culture of venous blood by the 10 th day after initiating
combined therapy.