L.A. is a 12-year-old girl (weight 40 kg) with polycystic kidney disease receiving 4-hour hemodialysis three times weekly. Her most recent SCr is 5.0 mg/dL. Vancomycin is initiated for a MRSA infection with 600 mg given 2 hours after hemodialysis. Which best characterizes the vancomycin dosing she will need?
A. She will need intermittent vancomycin dosing, likely twice weekly or less, and her dosing should be guided by vancomycin drug concentrations because it is difficult to determine the exact dose in advance.
B. She should receive a standard dose of vancomycin after each dialysis session because hemodialysis removes most of the vancomycin in her body.
C. All of her vancomycin should be administered during dialysis to minimize her risk of red man syndrome.
D. Her vancomycin clearance can be determined on the basis of her SCr and the Schwartz equation. Serum vancomycin concentrations can be measured to fine-tune dosing when at steady state in 1-2 days.