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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Is it less toxic than multiple daily doses and how should it be monitored? Comparative in vitro activity of three aminoglycosidic antibiotics: 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 nartford are not appropriate.
In addition to the well-known risk factors age, volume depletion, liver disease, co-administration of certain drugs, etc.
Curr Clin Top Infect Dis. Int J Clin Pharmacol Ther. Once-daily dosing nomoggam aminoglycosides. After calculating a dose, click on ‘Progress Note’ for a pharmacokinetic template or ‘Equations’ for a step-by-step explanation of the recommended dosing regimen.
Regardless, a conservative conclusion is that extended-interval dosing is at least as beneficial and safe, if not better, than conventional dosing.
The second simplified equation may be used at the bedside, which contains coefficients that are easier to memorize. Therefore, it is argued that nomograms based on an assumption of similar kinetics are invalid. Daily dosage of aminoglycosides.
Given the controversial and conflicting data, the significant heterogeneity of the primary literature, and the variety of different hartforrd for efficacy, nephrotoxicity, and ototoxicity, it is difficult to form an informed, definite conclusion regarding the benefit of extended-interval dosing versus conventional dosing. The bactericidal action of aminoglycosides is concentration dependent, i. This calculator uses four extended-interval nomograms.
The persistent low-level exposure of the target organism, as occurs with multiple daily dosing, may markedly reduce the antimicrobial activity of aminoglycosides.
Utilize the post-antibiotic effect PAEdefined as a recovery period before organisms can resume growth after drug removal. 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. There are a number of proposed benefits to extended-interval dosing compared to conventional dosing: A meta-analysis of extended-interval dosing versus multiple daily dosing of aminoglycosides.
Press ‘Calculate’ to view calculation results. You can tailor each drug model to fit your patient population, or you can create your own models.
Aminoglycoside uptake into renal tubule cells and the inner ear appears to be saturated at relatively low serum levels, suggesting that higher peaks do not necessarily result in a greater risk of toxicity. The three interval break points on the graphs are decay curves, produced by using a population average volume of distribution of 0.
Adjust maintenance dose using the Sawchuk and Zaske method. The authors of the Hartford nomogram then flattened these decay curves to simplify the nomogram.
Although definitive evidence is still lacking, animal and human studies strongly suggest that once-daily dosing is less nephrotoxic. The calculations utilized to arrive at these dosages as well as the rationale for each dosing strategy are described below.
IDMS is the newer, more precise method for measuring serum creatinine. Also, serum troughs that are at or near zero may promote tissue drug disposition, shorten tissue exposure, and promote recovery. Although the Barnes-Jewish nomogram has not been formally published, it is commonly used as an extended-interval nomogram.
Updated November 10, Dose Providing a dose is optional but encouraged This dose hartfotd used to determine the patient’s true corrected peak value. Obtain a mid-interval drug level 6 to 16 hours after the initial dose, then evaluate the interval based on the dosage adjustment nomogram.
Hartford Nomogram 3 The Hartford nomogram was ahrtford of the first published extended-interval nomograms. The rationale for high-dose extended-interval dosing of aminoglycosides is rooted in the following observations: