[Expert Solution]: While on CVVHD, a 65 yo with a BUN/Scr of 34/3

While on CVVHD, a 65 yo with a BUN/Scr of 34/3.2 is being treated with Vancomycin for MRSA necrotizing pneumonia. The MRSA isolate has a MIC of 1.5. The patient after the 2nd dose of 1 gram has the following levels return. 3/28 @0800 45 3/28 @1600 28 MAR 3/27 1800 MAR 3/28 0600 What dosing recommendation would you make and why? (please include what your goal concentrations are for the infection, what the current clearance (t 1/2) looks like, and what dosing regimen you would recommend assuming patient is remaining on CVVHD for next several days)