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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Experience with a once-daily aminoglycoside program administered to 2, adult patients. Int J Clin Pharmacol Ther. Drug Intell Clin Pharm.
Adjust maintenance dose using the 1-compartment Bayesian algorithm. Although definitive evidence is still lacking, animal and human studies strongly suggest that once-daily dosing is less nephrotoxic.
The bactericidal action of aminoglycosides is concentration dependent, i. The Bayesian method uses population-derived pharmacokinetic parameters ie.
The Hartford nomogram was one of the first published extended-interval hartfford. Barnes-Jewish 4 Although the Barnes-Jewish nomogram has not been formally published, it is commonly used as an extended-interval nomogram. The calculations utilized to arrive at these dosages as well as the rationale for each dosing strategy are described below.
Obtain a mid-interval drug level 6 to 16 hours after the initial dose, then evaluate the interval based on the dosage adjustment nomogram. The authors of the Hartford nomogram then flattened these decay curves to simplify the nomogram. Calculate elimination rate kel from creatinine clearance. nomogran
The following criteria are used by this calculator to determine an aminoglycoside dosing weight:. The rationale for high-dose extended-interval dosing of aminoglycosides is rooted in the following observations: Once daily aminoglycoside therapy.
For more information, read more about IDMS.
In addition to the well-known risk factors age, volume depletion, liver disease, hartfird of certain drugs, etc. Given the controversial and conflicting data, the significant heterogeneity of the primary literature, and the variety of different definitions nonogram efficacy, nephrotoxicity, and ototoxicity, it is difficult to form an informed, definite conclusion regarding the benefit of extended-interval dosing versus conventional dosing. Adjust maintenance dose using the Sawchuk and Zaske method.
Aminoglycoside Dosing Calculator This calculator may be used to calculate aminoglycoside using either once-daily and conventional dosing strategies dosing.
– Aminoglycoside Dosing Calculator
When a regimen is calculated, each step in the dosing process is fully enumerated and visible by clicking the “Equations” tab. Minimize the development of adaptive resistance by allowing a recovery period during the dosing interval. Drawn min prior to the next dose.
See the Edit drug models section of the help file for further information. Dosed mg IV Q hrs. Therefore, it is argued that nomograms based on an assumption of similar kinetics are invalid. The aminoglycoside model is not hard-coded into the program.
In vitro studies indicate that more frequent dosing of aminoglycosides tends to reduce their uptake into the bacterial cell of aerobic GNB. Hartford Nomogram 3 The Hartford nomogram was one of the first published extended-interval nomograms.
Printable Extended-Interval Aminoglycoside Nomograms
The second simplified equation may be used at the bedside, which contains coefficients that are easier to memorize. The PAE refers to the continued suppression of bacterial hartofrd despite the decline of the antimicrobial concentration to zero. Furthermore, extended-interval dosing provides for simpler hartfford calculations and reduced need for drug levels, which may reduce the risk of medication errors.
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: This aminoglycoside calculator uses a variety of published pharmacokinetic equations and principles to estimate an appropriate aminoglycoside regimen.
This calculator uses four extended-interval nomograms. Utilize the post-antibiotic effect PAEdefined as a recovery period before organisms can resume growth after drug removal.
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.
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. Louis, MObut it is available as an appendix in a meta-analysis that was published from the same institution.