Printable extendedinterval aminoglycoside nomograms. The hartford hospital extended interval aminoglycoside dosing nomogram referred to as the hartford nomogram is a simple and reliable clinical tool for determining an appropriate dosing interval for daily administration of gentamicin, tobramycin, and amikacin. The toxic nature of aminoglycoside antibiotics has led to the development of various dosing methods, in an attempt to maintain or optimize efficacy while minimizing toxic effects. The second method of extendedinterval therapy utilizes 5 mgkg of gentamicin or tobramycin in patients without renal dysfunction. The extendedinterval aminoglycoside dosing eiad concept, also known as oncedaily or single daily. Gentamicin guideline for use in adults hartford guidance.
A random level taken between 8 to 12 hours after the start of drug infusion may be used to. If patient is started on either gentamicin or tobramycin and has a uti, open fracturesurgery prophylaxis, cystitis, wound infections, pyelonephritis, or intraabdominalpelvic infection, 5 mgkg is warranted. School of pharmacy, university of connecticut, storrs. Extended interval dosing base on hartford nomogram i. However, existing guidelines for methods of administration and monitoring are nonspecific and may lead to excessive dosing. The complete but practical guide to aminoglycosides tl. Extended interval aminoglycoside monitoring and dosing guideline contact your local laboratory for hours of service or visit myhealth. Dosing and administration of parenteral aminoglycosides uptodate. Less aggressive therapeutic drug monitoring in this patient subpopulation can lead to significant. Observed 10hour concentrations after the initial dose were plotted on the hartford nomogram to determine an eligible dosing interval group q24h, q36h or q48h.
However, their use is associated with significant toxicities including vestibular, auditory and renal toxicity. Sbuh aminoglycoside dosing protocol antimicrobial stewardship program page 4 of 7 editors. Q48h q36h time start or infusion and sample draw hrs fig. Application of the hartford hospital nomogram for plazomicin dosing interval selection in patients with complicated urinary tract infection.
To maximise efficacy and safety, extended duration once daily or less. Jan 01, 2020 aminoglycosides weightbased dosing should harrtford based on ideal or adjusted body weight. Oncedaily aminoglycoside oda regimens have been instituted to maximize bacterial killing by optimizing the peak concentrationmic ratio and to reduce the potential for toxicity. Hartford nomogram for gentamicin tobramycin 7 mgkg. Aminoglycoside dosing and monitoring recommendations. Validation of the hartford nomogram in trauma surgery.
Once daily aminoglycoside dosing guidelines background. The department of pharmacy and pharmaceutical services now offers a dosing and monitoring service for patients receiving iv vancomycin and aminoglycoside therapy. Oncedaily aminoglycoside dosing is effective in treating gramnegative infections, including those associated with bones and joints. Use of ideal body weight ibw for determining the mgkgdose appears to be more accurate than dosing on the basis of total body weight tbw. A survey of extendedinterval aminoglycoside dosing practices in united states adult cystic fibrosis programs william a prescott jr pharmd introduction. Hartford, connecticut the hartford nomogram 3, 24, and. On the other hand, ototoxicity is usually considered irreversible. Pdf validation of the hartford nomogram in trauma surgery. Because the hartford nomogram was based on a dose of 7mgkg, if a lower dose is. The cystic fibrosis foundation recently deemed the use of extendedinterval dosing eid of aminoglycosides acceptable for the treatment of cystic fibrosis cf pulmonary exacerbations.
Pdf to validate the hartford nomogram for oncedaily aminoglycoside dosing in trauma surgery patients. Aminoglycoside dosing in patients with cystic fibrosis. Hartford hospital nomogram1 for gentamicintobramycin 7mgkg. Aminoglycoside dosing and monitoring guidelines for adult. We use hydration, we alter the dosing ideally switching to other medications if possible, and any other measures deemed necessary by nephrologists. The 7 mgkg dose uses the hartford nomogram for interval adjustment. It uses the highest dose of gentamicin and tobramycin 7 mgkg. Aminoglycoside adult and pediatric oncedaily initial dosing guidelines. Gentamicin tobramycin serum levels, adjust interval of subsequent doses, if need be, according to hartford nomogram. Aminoglycoside dosing and monitoring recommendations aminoglycoside antibiotics have limited tissue distribution, are dependent on renal elimination, and have a narrow therapeutic index.
The hartford nomogram suggests dividing an amikacin concentration by 2 to plot onto this. Hartford nomogram 3 the hartford nomogram was one of the first published extendedinterval nomograms. In trauma surgery patients with cl cr of more than 60 mlmin1. Aug 15, 2015 the risk of nephrotoxicity appears to be comparable with once and multipledaily aminoglycoside dosing. We initiated an oda program at our institution that utilizes a fixed 7mgkg. An update on current literature the advantages and disadvantages of oncedaily versus conventional dosing of aminoglycoside antibiotics are. The hartford nomogram method utilizes high dose, once daily dosing to optimize the peakmic ratio in the majority of clinical situations by administering a dose of 7mgkg of either gentamicin or tobramycin. National survey of extendedinterval aminoglycoside dosing. For obese patients total body weight 20% over ideal body weight, dosage requirement may best be estimated using an. Thus, careful selection of empiric dosing regimens and serum level monitoring are needed to ensure safety and efficacy of these drugs. Oncedaily aminoglycoside dosing has many advantages and has been widely advocated. Evaluation of four oncedaily aminoglycoside dosing nomograms. The traditional approach of aiming for target peak and trough concentrations is not appropriate for oncedaily dosing. Aminoglycoside dosing in adults department of health 4 1.
Trough level result of 1 mgl or more suggests accumulation. The hartford nomogram method utilizes high dose, once daily dosing to optimize the peakmic ratio in most clinical situations by administering a dose of 7mgkg of either gentamicin or tobramycin. Plot the measured gentamicin or tobramycin levels against the corresponding time elapsed in hours from the start of infusion on the hartford nomogram. The traditional approach to parenteral aminoglycoside dosing in. O if the level is above the 48 hour line stop the treatment. Unlike other nomograms, it uses the highest dose of gentamicintobramycin 7 mgkg versus 5 mgkg, which achieves a 40% higher peak. The hartford nomogram was one of the first published extendedinterval nomograms. This calculator uses the above equation to estimate aminoglycoside clearance. If an aminoglycoside is to be used, the clinician should recognize that extending aminoglycoside therapy beyond five days may place the patient at risk of aminoglycoside toxicity. Dosage adjustments should be made according to the hartford nomogram see below i. However, dosing nomograms are initial guidelines only. Extendedinterval aminoglycoside dosing eiad generally consists of administering the total daily dose as one dose, usually every 24 hours. Oncedaily aminoglycoside dosing in immunocompetent adults.
Hartford hospital nomogram1 for gentamicin tobramycin 7mgkg. A survey of extendedinterval aminoglycoside dosing practices. It is important to note that the hartford interval adjustment nomogram is only valid for a 7mgkg dose. Six nomograms were evaluated in patients with other infections. Infectious disease printable aminoglycoside nomograms nomogram hartford nomogram 1995 barnesjewish unpublished rochester 1997 urbancraig 1997. Aminoglycoside serum concentrations were repeated by 55 of 63 adult cf programs 87.
Monitor levels to adjust dose, target peak concentration is 20 to 30 mgl and target trough concentration is less than 1 mgl. O if the level falls on a line between dosing intervals choose the longer interval. Statement aminoglycosides are highly effective agents for the treatment of gramnegative infections. Aminoglycoside antibiotics have limited tissue distribution, are dependent on renal elimination, and have a narrow therapeutic index.
Aminoglycoside antibiotic bactericidal against many gram negative and some gram positive organisms. Vancomycin and aminoglycoside dosing and monitoring per pharmacy. Gentamicin is monitored using the hartford nomogram which relates observed concentrat ion to the time post dose within a given concentration range. On the basis of baseline crcl, a 15 or 10mgkg dose was simulated with the nomogram recommended dosing interval. This guide uses a constant dose of gentamicin of 7mgkg of ideal body weight.
The extendedinterval aminoglycoside dosing eiad concept, also known as oncedaily or single daily aminoglycoside dosing, is based on the 3 major pharmacodynamic characteristics of aminoglycoside antibiotics against gramnegative bacteria. O if the level falls in the area designated 24hours, 36hours or 48hours the dosing interval is 24, 36 or 48 hourly respectively. Nomograms hartford nomogram one of the first published extended interval nomograms 1995. Several nomograms have been developed to facilitate oncedaily dosing. Extendedinterval aminoglycoside dosing in pediatrics.
Once daily aminoglycoside dosing guidelines contd cystic fibrosis dosing crcl 60 mlmin. A nomogram for the less aggressive dose of 5mgkg was developed by a consensus panel illustrated below. If the patient is started on either gentamicin or tobramycin and has a suspected pseudomonas infection, pneumonia, osteomyelitis, meningitis, or sepsis, 7 mgkg is used to calculate the initial dose. We initiated an oda program at our institution that utilizes a fixed 7mgkg intravenous dose with a drug administration interval based on estimated creatinine clearance. This service is available 24 hours per day, 7 days. To use the hartford nomogram for 15mgkg doses of amikacin, multiply the druglevel scale by a factor of two. For synergistic treatment for grampositive infections, such as endocarditis please refer to umhs endocarditis treatment guidelines to determine which below strategy is preferred. Overall, gentamicin is more active against serratia marcescens. Aminoglycoside antibiotics continue to have a central role in the treatment of gramnegative infections. Typically, aminoglycoside induced nephrotoxicity is considered reversible. Extended interval dosing results in equal or less nephrotoxicity andor ototoxicity when compared to traditional dosing. Experience with a oncedaily aminoglycoside program. Thus far, peak gentamicin concentrations of 3 to 5 mcgml seem adequate for adjunctive therapy when using traditional dosing. Hartford hospital aminoglycoside dosing nomogram for plazomicin.
The hartford nomogram method utilizes highdose, once daily dosing to optimize the peakmic ratio in most clinical situations by administering a dose of 7mgkg. 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 tobramycin. This has largely superseded multiple daily dose regimens, and includes 5mgkg dosing, using the hartford nomogram, and individualised approaches. A suggested approach to oncedaily aminoglycoside dosing. Extended interval aminoglycoside monitoring and dosing guideline. Hartford hospital dosing nomogram gentamicin and tobramycin at 7mgkg i. Nomogram details were specified by only 3 programs. A serum aminoglycoside concentration at 614 hours 10 hours postinfusion after the first dose should be drawn. Obtain a random level 10 12 hours after dosing iii.
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