Overall, gentamicin is more active against serratia marcescens. The hartford nomogram was one of the first published extendedinterval nomograms. 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. Typically, aminoglycoside induced nephrotoxicity is considered reversible. 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. This service is available 24 hours per day, 7 days. Aminoglycoside dosing and monitoring recommendations.
The extendedinterval aminoglycoside dosing eiad concept, also known as oncedaily or single daily. Six nomograms were evaluated in patients with other infections. Several nomograms have been developed to facilitate oncedaily dosing. A serum aminoglycoside concentration at 614 hours 10 hours postinfusion after the first dose should be drawn. A survey of extendedinterval aminoglycoside dosing practices. Aminoglycoside serum concentrations were repeated by 55 of 63 adult cf programs 87. We use hydration, we alter the dosing ideally switching to other medications if possible, and any other measures deemed necessary by nephrologists. O if the level is above the 48 hour line stop the treatment.
Q48h q36h time start or infusion and sample draw hrs fig. In trauma surgery patients with cl cr of more than 60 mlmin1. Hartford hospital nomogram1 for gentamicintobramycin 7mgkg. The hartford nomogram method utilizes highdose, once daily dosing to optimize the peakmic ratio in most clinical situations by administering a dose of 7mgkg. Infectious disease printable aminoglycoside nomograms nomogram hartford nomogram 1995 barnesjewish unpublished rochester 1997 urbancraig 1997. An update on current literature the advantages and disadvantages of oncedaily versus conventional dosing of aminoglycoside antibiotics are. To use the hartford nomogram for 15mgkg doses of amikacin, multiply the druglevel scale by a factor of two. Aminoglycoside antibiotics continue to have a central role in the treatment of gramnegative infections. Thus, careful selection of empiric dosing regimens and serum level monitoring are needed to ensure safety and efficacy of these drugs. Hartford hospital dosing nomogram gentamicin and tobramycin at 7mgkg i. The 7 mgkg dose uses the hartford nomogram for interval adjustment. Hartford nomogram 3 the hartford nomogram was one of the first published extendedinterval nomograms. 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.
Oncedaily aminoglycoside oda regimens have been instituted to maximize bacterial killing by optimizing the peak concentrationmic ratio and to reduce the potential for toxicity. Pdf to validate the hartford nomogram for oncedaily aminoglycoside dosing in trauma surgery patients. To maximise efficacy and safety, extended duration once daily or less. On the other hand, ototoxicity is usually considered irreversible. Unlike other nomograms, it uses the highest dose of gentamicintobramycin 7 mgkg versus 5 mgkg, which achieves a 40% higher peak. This guide uses a constant dose of gentamicin of 7mgkg of ideal body weight. It is important to note that the hartford interval adjustment nomogram is only valid for a 7mgkg dose. 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. O if the level falls in the area designated 24hours, 36hours or 48hours the dosing interval is 24, 36 or 48 hourly respectively. 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. Hartford, connecticut the hartford nomogram 3, 24, and.
Oncedaily aminoglycoside dosing is effective in treating gramnegative infections, including those associated with bones and joints. The hartford nomogram suggests dividing an amikacin concentration by 2 to plot onto this. Extended interval dosing results in equal or less nephrotoxicity andor ototoxicity when compared to traditional dosing. Thus far, peak gentamicin concentrations of 3 to 5 mcgml seem adequate for adjunctive therapy when using traditional dosing. 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. However, dosing nomograms are initial guidelines only. Trough level result of 1 mgl or more suggests accumulation. Hartford nomogram for gentamicin tobramycin 7 mgkg. Aminoglycoside dosing and monitoring recommendations aminoglycoside antibiotics have limited tissue distribution, are dependent on renal elimination, and have a narrow therapeutic index. Aminoglycoside antibiotics have limited tissue distribution, are dependent on renal elimination, and have a narrow therapeutic index. The complete but practical guide to aminoglycosides tl.
Less aggressive therapeutic drug monitoring in this patient subpopulation can lead to significant. Aminoglycoside dosing in adults department of health 4 1. Once daily aminoglycoside dosing guidelines background. Aug 15, 2015 the risk of nephrotoxicity appears to be comparable with once and multipledaily aminoglycoside dosing. Validation of the hartford nomogram in trauma surgery. Gentamicin guideline for use in adults hartford guidance. Statement aminoglycosides are highly effective agents for the treatment of gramnegative infections. Application of the hartford hospital nomogram for plazomicin dosing interval selection in patients with complicated urinary tract infection. O if the level falls on a line between dosing intervals choose the longer interval.
Printable extendedinterval aminoglycoside nomograms. 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. Gentamicin tobramycin serum levels, adjust interval of subsequent doses, if need be, according to hartford nomogram. It uses the highest dose of gentamicin and tobramycin 7 mgkg. We initiated an oda program at our institution that utilizes a fixed 7mgkg. A survey of extendedinterval aminoglycoside dosing practices in united states adult cystic fibrosis programs william a prescott jr pharmd introduction. Gentamicin is monitored using the hartford nomogram which relates observed concentrat ion to the time post dose within a given concentration range. Hartford hospital aminoglycoside dosing nomogram for plazomicin. Observed 10hour concentrations after the initial dose were plotted on the hartford nomogram to determine an eligible dosing interval group q24h, q36h or q48h. Obtain a random level 10 12 hours after dosing iii.
Extendedinterval aminoglycoside dosing in pediatrics. Mar 27, 2020 the hartford nomogram was one of the first published extendedinterval unlike other nomograms, it uses the highest dose of gentamicintobramycin 7 mgkg. 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. However, existing guidelines for methods of administration and monitoring are nonspecific and may lead to excessive dosing. Oncedaily aminoglycoside dosing has many advantages and has been widely advocated. Nomograms hartford nomogram one of the first published extended interval nomograms 1995. Extended interval dosing base on hartford nomogram i. The department of pharmacy and pharmaceutical services now offers a dosing and monitoring service for patients receiving iv vancomycin and aminoglycoside therapy. For synergistic treatment for grampositive infections, such as endocarditis please refer to umhs endocarditis treatment guidelines to determine which below strategy is preferred.
School of pharmacy, university of connecticut, storrs. Hartford hospital nomogram1 for gentamicin tobramycin 7mgkg. However, their use is associated with significant toxicities including vestibular, auditory and renal toxicity. Experience with a oncedaily aminoglycoside program. Aminoglycoside adult and pediatric oncedaily initial dosing guidelines. National survey of extendedinterval aminoglycoside dosing. Aminoglycoside antibiotic bactericidal against many gram negative and some gram positive organisms. Extendedinterval aminoglycoside dosing eiad generally consists of administering the total daily dose as one dose, usually every 24 hours. The cystic fibrosis foundation recently deemed the use of extendedinterval dosing eid of aminoglycosides acceptable for the treatment of cystic fibrosis cf pulmonary exacerbations. They can produce substantial variations in serum concentrations and should be subsequently adjusted. Pdf validation of the hartford nomogram in trauma surgery.
A random level taken between 8 to 12 hours after the start of drug infusion may be used to. Monitor levels to adjust dose, target peak concentration is 20 to 30 mgl and target trough concentration is less than 1 mgl. For obese patients total body weight 20% over ideal body weight, dosage requirement may best be estimated using an. Aminoglycoside dosing and monitoring guidelines for adult. This calculator uses the above equation to estimate aminoglycoside clearance. Dosing and administration of parenteral aminoglycosides uptodate. 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. Extended interval aminoglycoside monitoring and dosing guideline contact your local laboratory for hours of service or visit myhealth.
Extended interval aminoglycoside monitoring and dosing guideline. Oncedaily aminoglycoside dosing in immunocompetent adults. Because the hartford nomogram was based on a dose of 7mgkg, if a lower dose is. A suggested approach to oncedaily aminoglycoside dosing. Vancomycin and aminoglycoside dosing and monitoring per pharmacy. Aminoglycoside dosing in patients with cystic fibrosis. Evaluation of four oncedaily aminoglycoside dosing nomograms.
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. The traditional approach of aiming for target peak and trough concentrations is not appropriate for oncedaily dosing. Nomogram details were specified by only 3 programs. Sbuh aminoglycoside dosing protocol antimicrobial stewardship program page 4 of 7 editors.
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