| (Name)HOSPITAL ONCE-DAILY AMINOGLYCOSIDE PROGRAM |
Initial Dosing Regimen - Determine the patient's creatinine clearance.
| Creatinine Clearance | Dose and Interval |
| > 60 ml/minute | 7 mg/kg every 24 hours |
| 40 to 60 ml/minute | 7 mg/kg every 36 hours |
| 20 to 40 ml/minute | 7 mg/kg every 48 hours |
| < 20 ml/minute | 7 mg/kg, then follow serial levels to determine time of next dose (level < 2 mg/ml) |
Dosing will be based on actual body weight unless the patient is morbidly obese (ie. 20% over ideal body weight (IBW). Obese Dosing Weight = IBW + 0.4(actual body weight - IBW).
For Tobramycin, M.D. must write "Do NOT Exchange." For Amikacin, use 15 mg/kg according to creatinine clearance. Amikacin level should be divided by 2 and apply to monogram.
Monitoring - Obtain a single random serum level after the first dose between 6-14 hours after the start of the infusion. (Name)Hospital prefers to draw the level 8 hours after 1 hour infusion. Therefore, monogram will be read at 9th hours. Evaluate on the nomogram (see below). If the level falls in the area designated Q24h, Q36h or Q48h the interval should be every 24, 36 or 48 hours, respectively, however, if the point is on the line one should choose the longer interval. If the random level is off the nomogram at the given time, the scheduled therapy should be stopped and serial levels followed to determine the appropriate time of the next dose (< 2 mg/ml).
Patient Exclusion - Pediatrics, Pregnancy, Burns (<20%), Ascites, Dialysis
(Name) Hospital Once-Daily Aminoglycoside Nomogram
Time between start of infusion and sample draw (hrs.)
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Sample Order: Gentamicin 560 mg in 250cc D5W Q36h. run over one hour. Draw random level 8 hours after the completion of infusion. Draw random level every third dose.