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Patients |
All adult patients requiring aminoglycoside therapy except in pregnancy, extensive burn, ascites, and severe renal insufficiency (CLcr < 30 mL/min). Also, neutropenic patients and those with enterococcal endocarditis are excluded.
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Dosage |
The single dose is 5 mg per kg of actual body weight (ABW) unless the patient is >20% heavier than the ideal body weight (IBW). For obese patients, a dosing weight should be calculated (for equations, see box below).
The calculated dose is diluted in 100 mL of normal saline and infused over one hour.
The dosing interval is determined by the creatinine clearance (CLcr):
| CLcr (mL/min) | >60 | 40 - 59 |
| Dosing interval (hours) |
24 |
36 |
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Monitoring |
A baseline serum creatinine (Scr) is necessary before initiating aminoglycoside therapy. Thereafter, Scr should be rechecked once or twice per week. In patients with adequate renal function (CLcr >60 mL/min), a trough aminoglycoside level should be <<1 mg/L. If this is found to be the case, the initial dosage may be maintained and no further drug levels are necessary as long as CLcr remains unchanged. If the trough level is ³1.0, an extension of the dosing interval will be necessary. Alternatively, an accurately timed random level may be obtained 6 - 16 hrs after the end of infusion. The reported random level is plotted on the graph shown below to determine the proper dosing interval. There is no need to obtain a peak level except in patients with markedly expanded volume of distribution. Ideally, the peak-to-MIC ratio should be ³ 10.
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References |
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