The Hartford nomogram was one of the first published extended-interval Unlike other nomograms, it uses the highest dose of gentamicin/tobramycin (7 mg/kg. Printable extended-interval aminoglycoside nomograms. The Hartford nomogram suggests dividing an amikacin concentration by 2 to plot onto this. Gentamicin is monitored using the Hartford nomogram which relates observ ed concentration to the time post dose within a given concentration range.
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Home Academy Blog About. Aminoglycoside Dosing Calculator This calculator may be used to calculate aminoglycoside using either once-daily and conventional dosing strategies dosing.
Calculate elimination rate kel from creatinine clearance. The rationale for high-dose extended-interval dosing of aminoglycosides is rooted in the following observations: In addition to the well-known risk factors age, volume depletion, liver disease, co-administration of certain drugs, etc.
Printable Extended-Interval Aminoglycoside Nomograms
Infusion time of 60 minutes This level represents the first aminoglycoside dose The level is drawn 6 to 14 hours after the start of the aminoglycoside infusion. Aminoglycosides weight-based dosing should be based on ideal or adjusted body weight.
hatrford Aminoglycosides exhibit a significant PAE against aerobic gram- negative bacteria. Although definitive evidence is still lacking, animal and human studies strongly suggest that once-daily dosing is less nephrotoxic. Some pk studies have shown that the pharmacokinetics of aminoglycosides at high doses differ significantly from those at traditional doses.
Although this higher dose has not been shown to improve clinical outcomes, it may be beneficial for institutions with higher average MICs to gentamicin or tobramycin. The second simplified equation may be harhford at the bedside, which contains coefficients that are easier to memorize. IDMS is the newer, more precise method for measuring serum creatinine.
Is it less toxic than multiple daily doses and how should it be monitored? These observations may have significant clinical implications.
Hartford Nomogram 3 The Hartford nomogram was one of the first published extended-interval nomograms. The three interval break points on the graphs are decay curves, produced by using a population average volume of distribution of 0.
The following patient populations should be excluded from the high-dose, extended-interval dosing and conventional dosing should be used: Longer dosing intervals appear to shorten the time required for the MIC to revert to its original value. Experience with a once-daily aminoglycoside program administered to 2, adult patients.
Nomograj aminoglycoside calculator uses a variety of published pharmacokinetic equations and principles to estimate an appropriate aminoglycoside regimen.
Furthermore, extended-interval dosing provides for simpler mathematical calculations and reduced need for drug levels, which may reduce the risk of medication errors. After calculating a dose, click on ‘Progress Note’ for a pharmacokinetic template or ‘Equations’ for a step-by-step explanation of the recommended dosing regimen.
Drawn min after the start of the infusion. The PAE phenomenon suggests that the aminoglycoside serum level may be allowed to fall below the MIC of the pathogen without compromising antimicrobial efficacy. This calculator may be used to calculate aminoglycoside using either once-daily and conventional dosing strategies dosing. The calculations utilized to arrive at these dosages as well as the rationale for each dosing strategy are described below.
This regimen can be completely empiric, where the dose is based on body weight, height, and creatinine clearance, or a regimen may be calculated based on one or more drug levels.
– Aminoglycoside Dosing Calculator
Because aminoglycosides are primarily renally eliminated, the elimination constant K el is directly related to the creatinine clearance: The aminoglycoside model is not hard-coded into the program. If the 6 to 16 hour level is undetectable and the infection is not responding, consider changing harrford a traditional dosing method. In vitro studies indicate that more frequent dosing of aminoglycosides tends to reduce their uptake into the bacterial cell of aerobic GNB.
This phenomenon “adaptive post-exposure resistance” is observed as an apparent increase in the MIC90 i. See the Edit drug models section of the help file for further information. Int J Clin Pharmacol Ther. You may select a specific nomogram by clicking the “Config” icon in the top, right-hand corner of this webpage. Determine initial maintenance dose MD i. Dosed mg IV Q nkmogram. Updated November 10, This dose is used to determine the patient’s true corrected peak value.
Most institutions are hsrtford IDMS by this point, but you should contacting your laboratory if you are unsure of your assay. The following criteria are used by this calculator to determine an aminoglycoside dosing weight:. Urban-Craig 6 The Urban-Craig nomogram was developed with an option for Q12h dosing, which is especially useful in younger patients with high aminoglycoside clearance who may have an inappropriately long interval of subtherapeutic drug levels.
Extended-interval dosing may hartforrd be appropriate in certain patient populations that have significantly altered pharmacokinetic parameters or in patients with hartfore states where very high peak levels are not appropriate.
There have been numerous clinical trials published attempting to determine whether extended-interval dosing is superior in efficacy or safety to conventional dosing.