In a study conducted by shimamoto et al 2015

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In a study conducted by Shimamoto et al . (2015), decreased cardiac clearance was seen in patients with a history of CHF. Although the mechanism by which cardiac function has an impact on vancomycin clearance is yet to be fully explained, renal blood flow is dependent on cardiac function. Vancomycin is excreted by kidneys, hence the assumption that vancomycin clearance will be affected by changes in cardiac function, which in return can lead to renal failure. According to Drenth-van Maanen et al. (2013), a medication that is subject to renal excretion will accumulate in the system if there is a decrease in glomerular filtration rate (GFR). When this happens, dosage needs to be adjusted accordingly in order to avoid adverse reactions. These authors explain that as the person ages, by nature the kidneys will have structural and functional changes, making this population more vulnerable to adverse
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reactions. After the age of 40, GFR will decline approximately 1 ml min -1 1.73 m -2 year -1 (Drenth-van Maanen et al., 2013). Our patient, in this case, is 65 years old so just by age alone, her kidney function had to be monitored. References Drenth -van Maanen , A. C., Jansen, P. A. F., Proost , J. H., Egberts , T. C. G., van Zuilen , A. D., van der Stap , D., & van Marum , R. J. (2013). Renal function assessment in older adults. British Journal Of Clinical Pharmacology, 76 (4), 616– 623. doi :10.1111/ bcp .12199 Shimamoto , Y., Fukuda , T., Tominari , S., Fukumoto , K., Ueno , K., Dong, M., … & Komori , K. (2013). Decreased vancomycin clearance in patients with congestive heart failure. European Journal Of Clinical Pharmacology, 69 (3), 449- 457. doi :10.1007/s00228-012- 1340-4 Vancomycin . (2017). Entire Monograph . Epocrates . Retrieved from https :// online . epocrates .com/drugs/137110/ vancomycin /Monograph Waineo , M. F., Kuhn, T.C., & Brown, D. L. (2015). The pharmacokinetic / pharmacodynamics rationale for administering vancomycin via continuous infusion. Journal Of Clinical Pharmacy And Therapeutics, 40 (3), 259- 265. doi :10.1111/ jcpt .12270 Response to a peer: Hi, Berta, Great informative post. Tuberculosis (TB) indeed is a serious infection that is difficult to eliminate. As you mentioned, it does take a long time to treat which is between 18 and 24 months
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(Tae Won et al., 2017). The higher the co-morbidity, the more difficult it is to treat. The list of medications used for TB treatment is extensive, and with it, a long list of side effects as well.
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