weight-based maintenance doses and longer dosing intervals based on creatinine clearance levels (Durand et al., 2018, p. 583). Furthermore, Alobaid et al. (2016) say providers should closely monitoring vancomycin pharmacokinetic profiles and increase the frequency of drug peak and trough levels, to ensure optimal pharmacokinetic and pharmacodynamic target levels are maintained (p. 262). Also, the plan should include managing the patient's obesity and newly diagnosed diabetes mellitus using a combination of diet and lifestyle modifications to reduce weight, as well as one or more antihyperglycemic agents to correct insulin resistance and beta-cell dysfunction associated with type 2 DM (Raz, 2013, p. S139). Finally, diabetic education and wound management should also be a priority for this patient to prevent future complications related to poorly managed DM and improper wound care. References Alobaid, A. S., Hites, M., Lipman, J., Taccone, F. S., & Roberts, J. A. (2016). Effect of obesity on the pharmacokinetics of antimicrobials and critically ill patients: A structured review. International Journal of Antimicrobial Agents, 47(4), 259-268. Durand, C., Bylo, M., Howard, B., & Belliveau, P. (2018). Vancomycin dosing in obese patients: Special considerations and novel dosing strategies. Annals of Pharmacotherapy, 52(6), 580-590.
Pai, M. P. (2016). Anti-infective dosing for obese adult patients: a focus on newer drugs to treat methicillin-resistant Staphylococcus aureus acute bacterial skin and skin structure infections. Clinical Therapeutics, 38(9), 2032-2044. Peterson, A. M. (2017). Pharmacokinetic basis of therapeutics and pharmacodynamic principles. In V. P. Arcangelo, A. M. Peterson, V. Wilbur, & J. A. Reinhold (Eds.), Pharmacotherapeutics for advanced practice: A practical approach (4th ed., pp. 17-31). Philadelphia, PA: Wolters Kluwer. Raz, I. (2013). Guideline approach to therapy in patients with newly diagnosed type 2 diabetes [Supplemental material]. Diabetes Care, 36(Suppl 2), S139-S144. Tran, M., & Elbarbry, F. (2016). Influence of diabetes mellitus on pharmacokinetics of drugs. MOJ Bioequivalence & Bioavailability, 2(1), 1-2. Retrieved from Vancomycin. (n.d.). Retrieved May 29, 2018, from - intravenous-injection.html Zosyn. (n.d.). Retrieved May 29, 2018, from
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