Amikacin conventional dosing1 peak 1540 mcgml trough once daily dosing. Gentamicin clinical guidelines for dosing and monitoring. If patients meet any of the following exclusion criteria, they arent candidates for once daily aminoglycoside dosing and must refer to traditional dosing. Once daily amikacin dosing in burn patients treated with. A serum aminoglycoside concentration at 614 hours 10 hours postinfusion after the first dose. As of apr 97, over 50 human clinical trials dealing with the oncedaily dosing. Mycobacterium infections orphan inhaled liposomal amikacin arikayce orphan designation. Subsequent doses can be given when pre dose level is monitoring level for once daily regimen aim for a pre dose. Patients with renal dysfunction andor those who are older may require 15 mg kg given 3 times a week. Experience with a oncedaily dosing program of aminoglycosides in.
This aminoglycoside calculator uses a variety of published pharmacokinetic equations and principles to estimate an appropriate aminoglycoside regimen. Consult the clinical microbiologist re dosing frequency for this indication. Once daily aminoglycosides are not recommended for infective endocarditis. What are the exclusion criteria for once daily dosing. Gentamicin clinical guidelines for dosing and monitoring of once daily gentamicin. In general, once daily administration is now recommended in most clinical situations. Thus, careful selection of empiric dosing regimens and serum level monitoring. Extendedinterval once daily aminoglycoside dosing 8. Because gentamicin is not metabolized, but is excreted in the urine, any loss of renal function without a concomitant decrease in the dose administered will inevitably lead to some increase in the average daily serum gentamicin. Additionally, monitor the cumulative dose maximum is 15 grams. If measured after 18 hours, the trough concentration must be less monitoring is recommended as a safety marker o should be checked at least once weekly for pediatric patients on aminoglycoside therapy o 30 minutes prior to a dose general dosing recommendations for gentamicin and tobramycin neonatal dosing. Experience with a oncedaily aminoglycoside program administered.
Aminoglycoside dosing and monitoring recommendations. The literature supports dosing ranges for amikacin and tobramycin of 3035 and 715 mg kgday, respectively, given once daily, with subsequent doses determined by therapeutic drug concentration. Amikacin sulphate is an aminoglycoside antibiotic with. Includes a 12hour dosing interval for patients with very fast clearance. Stanford health care aminoglycoside dosing guideline. Amikacin 15 mgkg dose divide level in half, then plot on graph follow up monitoring. Aminoglycoside dosing and monitoring recommendations aminoglycoside antibiotics have limited tissue distribution, are dependent on renal elimination, and have a narrow therapeutic index. Amikacin dosing, indications, interactions, adverse. Most infections typically respond in 24 to 48 hours. Its a simpler dosing process with less chance for calculation errors thats less time consuming and more costeffective. The dosing interval for gentamicin, tobramycin, and amikacin is based on crcl.
However, as in any clinical situation, there may be. Aminoglycosides ag include gentamicin, tobramycin, amikacin and streptomycin. Aminoglycoside dosing and monitoring guidelines for adult patients at stony. Empiric dosing and monitoring recommendations for amikacin in pediatric patients dosing for children less than 5 years or who have failed to achieve once daily goals in the past. Once daily gentamicin dosing in adults 3 monitoring requirements for aminoglycoside for different indications 7 vancomycin dosing and monitoring 8 teicoplanin dosing and monitoring 11 appendix 1. Dosage and administration 15mgkg once daily use actual body weight, unless obese, up to a maximum dose of 1. Experience with a oncedaily aminoglycoside program administered to. Aminoglycoside dosing in adults may 2018 queensland health.
Once daily dosage of arnikacin 15 mg kg is well tolerated in pediatric patients. Aminoglycoside antibiotics have limited tissue distribution, are dependent on renal elimination, and have a narrow therapeutic index. Oncedaily amikacin dosing in burn patients treated with. Dosing and administration of parenteral aminoglycosides uptodate. Dosage adjustment of aminoglycoside antibiotics based on. Aminoglycoside dosing and monitoring guidelines for adult. Gentamicin, an aminoglycoside with broad antimicrobial activity, is commonly used in both obstetrics and gynecology. Trough monitoring 3060 minutes prior to dose should be considered in patients demonstrating acute. Amikacin use and therapeutic drug monitoring in adults. In this study of 29 elderly patients with serious infections, amikacin 11 mg kg or 15 mg. Gentamicin, tobramycin and amikacin peak level post dose generally assesses whether a therapeutic level has been achieved, therefore levels not required for once daily dosing if peak too low. Experience with a oncedaily aminoglycoside program administered to 2,184. Thus, careful selection of empiric dosing regimens and serum level monitoring are needed to ensure safety and efficacy of these drugs.
Once daily dosing of amikacin is a novel therapy regimen which seems pharmacokinetically appropriate for the primary group of patients considered for aminoglycoside therapy. Amikacin levels can be processed daily including weekends but not out of hours. Aminoglycoside dosing guidelines for adults necessary patient information for dosing. Aminoglycoside dosing guidelines for adults necessary patient information for dosing ideal body weight ibw o use of ibw is recommended for aminoglycoside dosing unless patient meets criteria for utilization of abw or adbw. The hartford nomogram method utilizes highdose, once daily dosing to optimize the. Weekly monitoring of prolonged therapy with aminoglycosides.
The solution for intravenous use is prepared by adding the contents of a 500 mg. Dosage adiustment of aminoglvcoside antibiotics based on drug level monitoring in the period from the advent of therapeutic drug level monitoring in the late 1970s to the early 1990s, the dosage of aminoglycoside antibiotics was often adjusted based on measurement of two or more drug levels after a single dose. For obese patients total body weight 20% over ideal body weight, dosage requirement may best be estimated using an. Published two years later 1997, it uses the maximal daily dose of gentamicintobramycin approved by the fda 5 mgkg. Published two years later 1997, it uses the maximal daily dose of gentamicin tobramycin approved by the fda 5 mg kg.
Experience with a oncedaily aminoglycoside program administered to 2184. Designed to have drug concentrations mg ml for at least 4 hours, with a maximal postantibiotic effect of 16 hours. Extendedinterval aminoglycoside therapy also known as oncedaily. Once daily amikacin administration and monitoring protocol page 2 of 3. See hartford nomogram for monitoring of oncedaily dosing regimens. Oncedaily dosing of gentamicin in obstetrics and gynecology. Oncedaily aminoglycoside oda regimens have been instituted to maximize. Usually they are administered using once daily dosing. Therapeutic drug monitoring of patients receiving once daily aminoglycoside therapy can be performed using pharmacokinetic pk formulas or bayesian calculations. Pharmacokinetics of oncedaily amikacin in pediatric patients. Measured peaks averaged 28 mgl for twicedaily dosing and 4045 mgl for. Doses at extremes of bodyweight to avoid excessive dosage in obese patients, use ideal weight for height to calculate dose and monitor serum amikacin. For amikacin dosing consult the clinical pharmacist or therapeutic guidelines 14. The individual dose, the total daily dose, and the total cumulative dose of amikin are identical to the dose recommended for intramuscular administration.
This approach exploits the concentrationdependent killing and postantibiotic effect of. Use of ideal body weight ibw for determining the mg kg dose appears to be more accurate than dosing on the basis of total body weight tbw. Guidelines for once daily usage in adult and paediatric settings adult gentamicin once daily dosing guideline 1. In vitro, once daily dosing results in lower renal cortical concentrations compared to continuous infusions or traditional dosing and it is therefore hypothesised that once daily dosing may lessen nephrotoxicity. Pdf therapeutic drug monitoring of aminoglycosides in. Aminoglycoside dosing and monitoring chw this document reflects what is currently regarded as safe practice. The hartford nomogram method utilizes highdose, once daily dosing to optimize the peakmic ratio in the majority of clinical situations by administering a dose of 7mgkg of either gentamicin or. Experience with a oncedaily aminoglycoside program. Since initiation of the program, 2,184 patients have received this oda regimen. Traditional dosing regimens for gentamicin have called for 3 times daily dosing, but recent insights into the pharmacodynamics of the drug have led to multiple studies of once daily dosing. Currently many centers are adopting the once daily aminoglycosides or oda as their standard preferred dosing method for aminoglycosides.
Serum concentration sampling times for traditional and extendedinterval dosing. Once daily dosing is the recommended method of administration for aminoglycosides in. Aminoglycoside drug monitoring drug levels for patients with normal renal function on once daily dosing infuse tobramycin or amikacin dose over 30 minutes. Nicolau dp, freeman cd, belliveau pp, nightingale ch, ross jw, quintiliani r. Amikacin once daily dosing not for endocarditis or meningitis amikacin twice daily dosing for endocarditis or meningitis dose. Once daily amikacin administration and monitoring protocol. Mic of 8 to 10 using standard once daily amikacin doses of 15 mg kg. What do i need to know about aminoglycoside antibiotics. By the year 2000, this figure may be as high as 80%. Although their recommended method for monitoring aminoglycosides was a computerized method with a dosage.
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