Augmented Renal Clearance of Vancomycin and Levetiracetam in a Traumatic Brain Injury Patient

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.