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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Adjust maintenance dose using the 1-compartment Bayesian algorithm. The authors of the Hartford nomogram then flattened these decay curves to simplify nomoogram nomogram. Comparative in vitro activity of three aminoglycosidic antibiotics: Utilize the post-antibiotic effect PAEdefined as a recovery period before organisms can resume growth after drug removal.
This calculator may be used to calculate aminoglycoside bomogram either once-daily and conventional dosing strategies dosing. Minimize the development of adaptive resistance by allowing a recovery period during the dosing interval.
In vitro studies indicate that more frequent dosing of aminoglycosides tends to reduce their uptake into the bacterial cell of aerobic GNB.
Home Academy Blog About. 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: There are a number of proposed benefits to extended-interval dosing compared to conventional dosing: Accessed December 31, Curr Clin Top Infect Dis.
The Hartford nomogram was one of hqrtford first published extended-interval nomograms. Therefore, it is argued that nomograms based on an assumption of similar kinetics are invalid. Also, serum troughs that are at or near zero may promote tissue drug disposition, shorten tissue exposure, and promote recovery. Longer dosing intervals appear to shorten the time required for the MIC to revert to its original value.
Press ‘Calculate’ to view calculation results. Drug Intell Clin Pharm. Experience with a once-daily aminoglycoside program administered to 2, adult patients. Most institutions are using IDMS by this point, but you should contacting your laboratory if you are unsure of your assay. The bactericidal action of aminoglycosides is concentration dependent, i. Given the controversial and conflicting data, hhartford 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 hartforr extended-interval dosing versus conventional dosing.
A meta-analysis of extended-interval dosing versus multiple daily dosing of aminoglycosides.
Dose Providing a dose is optional but encouraged This dose is used to determine the patient’s true corrected peak value. When a regimen is calculated, nomigram step in the dosing process is fully enumerated and visible by clicking the “Equations” tab.
– Aminoglycoside Dosing Calculator
Furthermore, some have questioned the validity of all ODA nomograms because they are based on one-compartment parameters derived from studies of traditional hartfford methods. Calculate elimination rate kel from creatinine clearance. Some pk studies have shown that the pharmacokinetics of aminoglycosides at high doses differ significantly from those at traditional doses.
This calculator uses the above equation to estimate aminoglycoside clearance.
Obtain a mid-interval drug level 6 to 16 hours after the initial hartforr, then evaluate the interval based on the dosage adjustment nomogram. Dosed mg IV Q hrs. Assumptions of this level: The calculations utilized to arrive at these dosages as well as the rationale for each dosing strategy are described below.
The parameters are found in the drug model database and are fully user-editable. Drawn min after the start of the infusion. Once daily aminoglycoside therapy. Regardless, a conservative conclusion is that nomofram dosing is at least as beneficial and safe, if not better, than conventional dosing.
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. Aminoglycosides weight-based dosing should be based on ideal or adjusted body weight.
For more information, read more about IDMS. Furthermore, extended-interval dosing provides for simpler mathematical calculations and reduced need for drug levels, which may reduce the risk of medication errors.
Nomoram persistent low-level exposure of the target organism, as occurs with multiple daily dosing, may markedly reduce the antimicrobial activity of aminoglycosides.
The PAE phenomenon suggests that the aminoglycoside serum level may be allowed to fall below the MIC of the pathogen without compromising antimicrobial nomogdam.