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.
|Published (Last):||14 July 2008|
|PDF File Size:||9.58 Mb|
|ePub File Size:||9.14 Mb|
|Price:||Free* [*Free Regsitration Required]|
Obtain a mid-interval drug level 6 to 16 hours after the initial dose, then evaluate the interval based on the dosage adjustment nomogram.
Comparative in vitro activity of three aminoglycosidic antibiotics: When a regimen is calculated, each step in the dosing process is fully enumerated and visible by clicking nomgram “Equations” tab. See the Edit drug models section of the help file for further information. The aminoglycoside model is not hard-coded into the program. BB-K8, kanamycin, and gentamicin. Therefore, it is argued that nomograms based on an assumption of similar kinetics are invalid.
Aminoglycoside Dosing Calculator This calculator may be nomograj to calculate aminoglycoside using either once-daily and conventional dosing strategies dosing. Aminoglycoside Calculator Advanced aminoglycoside pharmacokinetics tool ClinCalc.
Utilize the post-antibiotic effect PAEdefined as a recovery period before organisms can resume growth after drug removal. Minimize the development of adaptive resistance by allowing a recovery period during the dosing interval. This phenomenon “adaptive post-exposure resistance” is observed as an apparent increase in the MIC90 i.
Hartford Nomogram 3 The Hartford nomogram was one of the first nomogra, extended-interval nomograms.
– Aminoglycoside Dosing Calculator
Interval is based on creatinine clearance. Right hand Right arm below elbow Right arm whole arm Right foot Right leg below knee Right leg above knee. Is it less toxic nnomogram multiple daily doses and how should it be monitored? The parameters are found in the drug model database and are fully user-editable.
Barnes-Jewish 4 Although the Barnes-Jewish nomogram has not been formally published, it is commonly used as an extended-interval nomogram. 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.
Drawn min after the start of the infusion.
You can tailor each drug model to fit your patient nomogarm, or you can create your own models. Curr Clin Top Infect Dis. Daily dosage of aminoglycosides. If the 6 to 16 hour level is undetectable and the infection is not responding, consider changing to a traditional dosing method. For more information, read more about IDMS. Accessed December 31, Dosed mg IV Q hrs. Louis, MObut it is available as an appendix in a meta-analysis that was published from the same institution.
The duration of this effect 2 – 8 hours depends on several factors, chief among noogram the height of the preceding aminoglycoside peak. There have been numerous clinical trials published attempting to determine whether extended-interval dosing is superior in efficacy or safety to conventional dosing. The nomogram is no longer available as a webpage via the Barnes-Jewish Hospital St.
It is important to note that this method relies on an accurate creatinine clearance; therefore, this method nomgoram not be appropriate in patients with unstable renal function or those with difficult-to-estimate creatinine clearance.
These observations may have significant clinical implications. Extended-interval dosing may not be appropriate in certain patient populations that have significantly altered pharmacokinetic parameters or in patients with disease states where very high peak levels are not appropriate. The persistent low-level nojogram of the target organism, as occurs with multiple daily dosing, may markedly reduce the antimicrobial activity of aminoglycosides.
Given the bomogram and conflicting data, the significant heterogeneity of the primary literature, and the variety of different definitions for efficacy, nephrotoxicity, and ototoxicity, it is difficult to form an informed, definite conclusion regarding the benefit of extended-interval nonogram versus conventional dosing.
Aminoglycosides weight-based dosing should be based on ideal or adjusted body weight. Although the Barnes-Jewish nomogram has not hargford formally published, it is commonly used as an extended-interval nomogram. The bactericidal action of aminoglycosides is concentration dependent, i.
The three interval break points on the graphs are decay curves, produced by using a population average volume of distribution of 0. This aminoglycoside calculator uses a variety of published pharmacokinetic equations and principles to estimate an nomogrwm aminoglycoside regimen. The rationale for high-dose extended-interval dosing of aminoglycosides is rooted in the following observations: Regardless, a conservative conclusion is that extended-interval dosing is at least as beneficial and safe, if not better, than conventional dosing.
The following criteria are used by this calculator to nomovram an aminoglycoside dosing weight:. You may select a specific nomogram by clicking the “Config” icon in the top, right-hand corner of this webpage. Also, serum troughs that are at or near zero may promote tissue drug disposition, shorten nomoyram exposure, and promote recovery.
Although definitive evidence is still lacking, animal and human studies strongly suggest that once-daily dosing is less nephrotoxic. The following patient populations should be excluded from the high-dose, extended-interval dosing and conventional dosing should be used: Experience with a once-daily aminoglycoside program administered to 2, adult patients.
Minimize nephrotoxicity by administering larger, less frequent doses and potentially decreasing renal cortical aminoglycoside concentrations. Furthermore, extended-interval dosing provides for simpler mathematical calculations and reduced need for drug levels, which may reduce the risk of medication errors. 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.
A meta-analysis of extended-interval dosing versus multiple daily dosing of aminoglycosides. Determine initial maintenance dose MD i. This calculator may be used to calculate aminoglycoside using either once-daily and conventional dosing strategies dosing.
Press ‘Calculate’ to view calculation results.