A recent study found that clinical and economic outcomes are improved for patients whose vancomycin therapy is managed by pharmacists.1 Pharmacokinetics is useful in predicting serum vancomycin concentrations (SVCs) and allows for the individualization of dosage regimens. Various vancomycin dosing methods have been described and are based on patient-specifi c factors such as weight, creatinine clearance (CL cr ), and age.2-7 In a study of veterans, Leonard and Boro 2 found that the equations CL = 0.9 × CL cr (mL/min/kg) × ABW and V = 0.7 L/kg × ABW better predicted SVCs than the conventional method (CL = 0.65 × CL cr [mL/min/kg] × ABW and V = 0.7 L/kg × ABW), where V = volume of distribution, ABW = actual body weight in kilograms, CL = vancomycin clearance in milliliters per minute, and CL cr is based on a derivation of the Cockcroft and Gault equation, 8 where no weight is entered to generate a CL cr in milliliters per minute per kilogram. The 0.9 × CL cr factor was derived retrospectively from regression analysis. Given the limitations in their plasma sampling strategy, which predominantly measured trough vancomycin concentrations, and sample size, Leonard and Boro 2

Uterine leiomyoma is the most common benign tumor of the uterus found in reproductive-aged women, however, rupture of blood vessel overlying a uterine myoma is extremely rare. In this case, we described a case of the spontaneous bleeding of superficial vessels overlying a 3×4 cm sized subserosal myoma in a woman with low abdominal pain. Spontaneous rupture of a superficial vessel of leiomyoma can cause acute abdominal pain and hemoperitoneum. Although this is a very rare complication of uterine leiomyoma, considering of the high prevalence of uterine myoma, we should keep in mind this complication in work-up of patient with hemoperitoneum.