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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The bactericidal action of aminoglycosides is concentration dependent, i. Dose Providing a dose is optional but encouraged This dose is used to determine the patient’s true corrected peak value.
When a regimen is calculated, each step in the dosing process is fully enumerated and visible by clicking the “Equations” tab. You may select a specific nomogram by clicking the “Config” icon in the top, right-hand corner of this webpage. Utilize the post-antibiotic effect PAEdefined as a recovery period before organisms can resume growth after drug removal. Curr Clin Top Infect Dis. The persistent low-level exposure of the target organism, as occurs with multiple daily dosing, may markedly reduce the antimicrobial activity of aminoglycosides.
Although definitive evidence is still lacking, animal and human studies strongly suggest that once-daily dosing is less nephrotoxic. Regardless, a conservative conclusion is that extended-interval dosing is at least as beneficial and safe, if not better, than conventional dosing.
Calculate elimination rate kel from creatinine clearance. Right hand Right arm below elbow Right arm whole arm Right foot Right leg below knee Right leg above knee. Aminoglycoside Dosing Calculator This calculator may be used to calculate aminoglycoside using either once-daily and conventional dosing strategies dosing. For more information, read more about IDMS. The nomogram is no longer available as a webpage via the Barnes-Jewish Hospital St.
Aminoglycoside Calculator –
The PAE refers to the continued suppression of bacterial growth despite the decline of the antimicrobial concentration to zero. It is important to note that this method relies on an accurate creatinine clearance; therefore, this method may not be appropriate in patients nomogfam unstable renal function or those with difficult-to-estimate creatinine clearance.
The following patient populations should be excluded from the high-dose, extended-interval dosing and conventional dosing should be used: Home Academy Blog About. 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.
Determine initial maintenance dose MD i.
This calculator may be used to calculate aminoglycoside using either once-daily and conventional dosing strategies dosing. You can tailor each drug model to fit your patient population, or you can create your own models. BB-K8, kanamycin, and gentamicin. Aminoglycoside uptake into renal tubule cells and the inner ear appears to be saturated at relatively low serum levels, suggesting that higher peaks do not necessarily result in a greater risk of toxicity.
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. The theoretical benefits of high-dose, extended-interval dosing are to: The Hartford nomogram was one of the first published extended-interval nomograms.
Louis, MObut it is available as an appendix in a meta-analysis that was published from the same institution.
Furthermore, some have questioned the validity of all ODA nomograms because they are based on one-compartment parameters derived from studies of traditional dosing methods. 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. Accessed December 31, Comparative in vitro activity of three aminoglycosidic antibiotics: Once daily aminoglycoside therapy.
The PAE phenomenon suggests that the aminoglycoside serum level may be allowed to fall below the MIC of the pathogen without compromising antimicrobial efficacy. Interval is based on creatinine clearance. Some pk studies have shown that the pharmacokinetics of aminoglycosides at high nomgoram differ significantly from those at traditional doses.
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. In vitro studies indicate that more frequent dosing of nomogrwm tends to reduce their uptake into the bacterial cell of aerobic GNB.
Drawn min after the start of the infusion.
The parameters are found in the drug model database and are fully user-editable. In addition to the hartfrd risk factors age, volume depletion, liver disease, co-administration of certain drugs, etc. This calculator uses four extended-interval nomograms.