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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Once daily aminoglycoside therapy. This aminoglycoside calculator uses a variety of published pharmacokinetic equations and principles to estimate an appropriate aminoglycoside regimen. This calculator uses the above equation to estimate aminoglycoside clearance. The persistent low-level exposure of the target organism, as occurs with multiple daily dosing, may markedly reduce the antimicrobial activity of aminoglycosides. You may select a specific nomogram by clicking the “Config” icon in the top, right-hand corner of this webpage.
In vitro nomohram indicate that more frequent dosing of aminoglycosides tends to reduce their uptake into the bacterial cell of aerobic GNB. Adjust maintenance dose using the Sawchuk and Zaske method.
These observations may have significant clinical implications. Calculate elimination rate kel from creatinine clearance. Int J Clin Pharmacol Ther. The Hartford nomogram was one of the first published extended-interval nomograms.
Updated November 10, The parameters are found in the drug model database and are fully user-editable. This calculator uses four extended-interval nomograms. When a regimen is calculated, each step in the dosing process is fully enumerated and visible by clicking the “Equations” tab. 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 gartford or more drug levels.
The second simplified equation may be used at the bedside, which contains coefficients that are easier hartfrod memorize. In addition to the well-known risk factors age, volume depletion, liver disease, co-administration of certain drugs, etc.
Drawn min after the start of the infusion.
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 PAE phenomenon suggests that the aminoglycoside serum level may be allowed to fall below the MIC of the pathogen without compromising antimicrobial efficacy.
Assumptions of this level: 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 rationale for high-dose extended-interval dosing of aminoglycosides is rooted in the following observations: Therefore, it is argued that nomograms based on an assumption of similar kinetics are invalid.
See the Edit drug models section of the help file for further information.
– Aminoglycoside Dosing Calculator
Curr Clin Top Infect Dis. The Bayesian method uses population-derived pharmacokinetic parameters ie. Given the controversial and conflicting data, the significant heterogeneity of the nomogra 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 dosing versus conventional dosing.
Click this icon button to either include or ignore the patient’s dose for the calculation. 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. Some pk studies have shown that the pharmacokinetics of aminoglycosides at high doses differ significantly from those at traditional doses.
The calculations utilized to arrive at these dosages as well as the rationale for each dosing strategy are described below. Aminoglycoside Calculator Advanced aminoglycoside pharmacokinetics tool ClinCalc. Furthermore, some have questioned the validity of all ODA nomograms because they are based on nomogeam parameters derived from studies of traditional dosing methods.
Interval is based on creatinine clearance.
The following patient populations should be excluded from the high-dose, extended-interval dosing and conventional dosing should be used: The PAE refers to the continued suppression of bacterial growth despite the decline of the antimicrobial concentration to zero.
Furthermore, extended-interval dosing provides for simpler mathematical calculations and reduced need for drug levels, which may reduce the risk of medication errors.
This dose is used to determine the patient’s true corrected peak value. Aminoglycoside uptake into renal tubule cells and the inner ear appears to be saturated at relatively low serum levels, suggesting nomograj higher peaks do not necessarily result in a greater risk of toxicity.
This phenomenon “adaptive post-exposure resistance” is observed as an apparent increase in the MIC90 i.