A patient on long-term vancomycin therapy for MRSA endocarditis develops nephrotoxicity. The renal injury pattern and the monitoring parameter used to guide therapy are BEST described as:
- A Glomerulonephritis; AUC/MIC ratio of vancomycin
- B Proximal tubular injury via oxidative stress; AUC0-24/MIC target of 400–600 ✓
- C Collecting duct dysfunction; peak vancomycin level < 40 mcg/mL
- D Interstitial nephritis via immune mechanism; trough level only
Correct answer: B. Proximal tubular injury via oxidative stress; AUC0-24/MIC target of 400–600
Explanation
Vancomycin-induced nephrotoxicity primarily affects proximal tubular cells via reactive oxygen species generation. Current guidelines (ASHP/IDSA/SIDP 2020) recommend AUC-guided monitoring with an AUC0-24/MIC target of 400–600 mg·h/L for serious MRSA infections, as this correlates better with both efficacy and nephrotoxicity avoidance compared to trough-only monitoring. Trough-only monitoring (option D) is now outdated as the sole parameter.
Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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