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 parameters are found in the drug model database and are fully user-editable. Hartdord institutions are using IDMS by this point, but you should contacting your laboratory if you are unsure of your assay. Adjust maintenance dose using the Sawchuk and Zaske method. You may select a specific nomogram by clicking the “Config” icon in the top, right-hand corner of this webpage. Dose Providing a dose is optional but encouraged This dose is used to determine the patient’s true corrected peak value.
Right hand Right arm below elbow Right arm whole arm Right foot Right leg below knee Right leg above knee. The persistent low-level exposure of the target organism, as occurs with multiple daily dosing, may markedly reduce the antimicrobial activity of aminoglycosides. In addition to the well-known nomoggram factors age, volume depletion, liver disease, co-administration of certain drugs, etc.
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. For more information, read more about IDMS. Minimize nephrotoxicity by administering larger, less frequent doses and potentially hartfore renal cortical aminoglycoside concentrations.
See the Edit drug hartfoed section of the help file for further information.
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. The Hartford nomogram was one of the first published extended-interval nomograms.
Hartford Nomogram 3 The Hartford nomogram was one of the first published extended-interval nomograms.
Determine initial maintenance dose MD i. The authors of the Hartford nomogram then flattened these decay curves to simplify the nomogram. The Bayesian method uses population-derived pharmacokinetic parameters ie. When a regimen is calculated, each step in the dosing process is fully enumerated and visible by clicking the “Equations” tab.
These observations may have significant clinical implications. Aminoglycoside Calculator Advanced aminoglycoside pharmacokinetics tool ClinCalc. The three interval break points on the graphs are decay curves, produced by using a population average volume of distribution of 0.
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. 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.
Aminoglycosides weight-based dosing should be based on ideal or adjusted body weight. Although harttord evidence is still lacking, animal and nmoogram studies strongly suggest that once-daily hratford 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.
This aminoglycoside calculator uses a variety of published pharmacokinetic equations and principles to estimate an appropriate aminoglycoside regimen. Drawn min prior to the next dose.
This phenomenon “adaptive post-exposure resistance” is observed as an apparent increase in the MIC90 i. Home Academy Blog About. Regardless, a conservative conclusion is that extended-interval dosing is at least as beneficial and safe, if not better, than conventional dosing. Click this icon button to either include or ignore the patient’s dose for the calculation.
Although the Barnes-Jewish nomogram has not been formally published, it is commonly used as an extended-interval nomogram.
This calculator was specifically designed to help students and clinicians understand the process of calculating an aminoglycoside regimen.
Assumptions of this level: Daily dosage of aminoglycosides. The PAE refers to the continued suppression of bacterial growth despite the decline of the antimicrobial concentration to zero. This calculator may be used to calculate aminoglycoside using either once-daily and conventional dosing strategies dosing.
Furthermore, extended-interval dosing provides for simpler mathematical calculations and reduced hhartford for drug levels, which may reduce the risk of medication errors.
This calculator uses the above equation to estimate aminoglycoside clearance. 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. Updated November 10, 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.
Because aminoglycosides are primarily renally eliminated, the elimination constant K el is directly related to the creatinine clearance: Drug Intell Clin Pharm. The rationale for high-dose extended-interval dosing of aminoglycosides is rooted in the following observations: Interval is based hartvord creatinine clearance.
Aminoglycoside Calculator –
Aminoglycoside Dosing Calculator This calculator may be used to calculate aminoglycoside using either once-daily and conventional dosing strategies dosing.
You can tailor each drug model to fit your patient population, or you can create your own models. A meta-analysis of extended-interval dosing versus multiple daily dosing of aminoglycosides.
Dosed mg IV Q hrs. Aminoglycosides exhibit a significant PAE against aerobic gram- negative bacteria. Also, serum troughs that are at or near zero may promote tissue drug disposition, shorten tissue exposure, and promote recovery.
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.