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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Assumptions of this level: These observations may have significant clinical implications. 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.
Dose Providing a dose is optional but encouraged This dose is used to determine the patient’s true corrected peak value.
Printable Extended-Interval Aminoglycoside Nomograms –
Although definitive evidence is still nomogfam, animal and human studies strongly suggest that once-daily dosing is less nephrotoxic. The duration of this effect 2 – 8 hours depends on several factors, chief among them the height of the preceding aminoglycoside peak.
The PAE refers to the continued suppression of bacterial growth despite the decline of the antimicrobial concentration to zero. Because aminoglycosides are primarily renally eliminated, the elimination constant K el is noogram related to the creatinine clearance: Although the Barnes-Jewish nomogram has not been formally published, it is commonly used as an extended-interval nomogram.
Some pk studies have shown that the pharmacokinetics of aminoglycosides at high doses differ significantly from those at traditional doses. A meta-analysis of extended-interval dosing versus multiple daily dosing of aminoglycosides. 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.
This regimen can be completely empiric, where the dose is based on body weight, height, and creatinine clearance, or a nnomogram may be calculated based on one or more drug levels.
Longer dosing intervals appear to shorten the time required for the MIC to revert to its original value.
The authors of the Hartford nomogram then flattened these decay curves to simplify the nomogram. 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 nomogram is no longer available as a webpage via the Barnes-Jewish Hospital St. Aminoglycoside Calculator Advanced aminoglycoside pharmacokinetics tool ClinCalc. Most institutions are using IDMS by this point, but you should contacting your laboratory if you are unsure of your assay.
Also, serum troughs that are at or near zero may promote tissue drug disposition, shorten tissue exposure, and promote recovery.
For more information, read more about IDMS. Right hand Right arm below elbow Right arm whole arm Right foot Right leg below knee Right leg above knee.
The aminoglycoside model is not nimogram into the program. Drug Hartfrod Clin Pharm. Drawn min prior to the next dose. The following patient populations should be excluded from the high-dose, hartdord dosing and conventional dosing should be used: 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.
This phenomenon “adaptive post-exposure resistance” is observed as an apparent increase in the MIC90 i. Louis, MObut it is available as an appendix in a meta-analysis that was published from the same institution. This aminoglycoside calculator uses a variety of published pharmacokinetic equations and principles to estimate an appropriate aminoglycoside regimen. The following criteria are used by this calculator to determine an aminoglycoside dosing weight:.
Determine initial maintenance dose MD i. Aminoglycosides weight-based dosing should be based on ideal or adjusted body weight. Accessed December 31, Obtain a mid-interval drug level 6 to 16 hours after the initial dose, then evaluate the interval based on the dosage adjustment nomogram. Experience with a once-daily aminoglycoside program administered to 2, hartfotd patients. Click this icon button to either include or ignore the patient’s dose for the calculation.
Press ‘Calculate’ to view calculation results. Minimize nephrotoxicity by administering larger, less frequent doses and potentially nokogram renal cortical aminoglycoside concentrations. 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. IDMS is the newer, more precise method for measuring serum creatinine.
Minimize the development of adaptive resistance by allowing a recovery period during the dosing interval. If the 6 to 16 hour level is undetectable and the infection is not responding, consider changing to a traditional dosing method. This calculator may be used to calculate aminoglycoside using either once-daily and conventional dosing strategies dosing.
Utilize the post-antibiotic effect PAEdefined as a recovery period before organisms can resume growth after drug removal. Dosed mg IV Q hrs.