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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The PAE refers to the continued suppression of bacterial growth despite the decline of the antimicrobial concentration to zero.
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. Minimize the development of adaptive resistance by allowing a recovery period during the dosing interval.
Aminoglycosides exhibit a significant PAE against aerobic gram- negative bacteria.
Int J Clin Pharmacol Ther. Once-daily dosing of aminoglycosides. Although the Barnes-Jewish nomogram has not been haftford published, it is commonly used as an extended-interval nomogram. This phenomenon “adaptive post-exposure resistance” is observed as an apparent increase in the MIC90 i.
Home Academy Blog About. The PAE phenomenon suggests that the aminoglycoside serum level may be allowed to fall below the MIC of the pathogen nomofram compromising antimicrobial efficacy. The following patient populations should be excluded from the high-dose, extended-interval dosing and conventional dosing should be used: Minimize nephrotoxicity by administering larger, less frequent doses and potentially decreasing renal cortical aminoglycoside concentrations.
Calculate elimination rate kel from creatinine clearance.
Accessed December 31, Regardless, a conservative conclusion is that extended-interval dosing is at least as beneficial and safe, if not better, than conventional dosing. Furthermore, some have questioned ahrtford validity of all ODA nomograms because they are based on one-compartment parameters derived from studies of traditional dosing methods. This aminoglycoside calculator uses a variety of published pharmacokinetic equations and principles to estimate an appropriate aminoglycoside regimen.
You can tailor each drug model to fit your patient population, or you can create your own models. 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.
Is it less toxic than multiple daily doses and how should it be monitored?
Printable Extended-Interval Aminoglycoside Nomograms –
Determine initial maintenance dose MD i. Obtain a mid-interval drug level 6 to 16 hours after the initial hargford, then evaluate the interval based on the dosage adjustment nomogram.
The nomogram is no longer available as a webpage via the Barnes-Jewish Hospital St. Although definitive evidence is still lacking, animal and human studies strongly suggest that once-daily dosing is less nephrotoxic.
The persistent low-level exposure of the target organism, as occurs with multiple daily dosing, may markedly reduce the antimicrobial activity of aminoglycosides. There are a number of proposed benefits to extended-interval dosing compared to conventional dosing: Click this icon button to either include or ignore the patient’s dose for the calculation.
This calculator uses the above equation to estimate aminoglycoside clearance. The aminoglycoside model is not hard-coded into the program. The parameters are found in the drug model database and are fully user-editable. It is important to note that this method relies on an accurate creatinine clearance; therefore, this method may not be appropriate in patients with unstable renal function or those with difficult-to-estimate creatinine clearance.
Also, serum troughs that are at or near zero may promote tissue drug disposition, shorten tissue exposure, and promote recovery. Utilize the post-antibiotic effect PAEdefined as a recovery period before organisms can resume growth after drug removal.
A meta-analysis of extended-interval dosing versus multiple daily dosing of aminoglycosides. Curr Clin Top Infect Yartford. Dose Providing a dose is optional but encouraged This dose is used to determine the patient’s true corrected peak value. Longer dosing intervals appear to shorten the time required for the MIC to revert to its original value. This calculator was specifically designed to help students and clinicians understand the process of calculating an aminoglycoside regimen.