YHOVN 2 năm trước

Aminoglycoside Protocols

Aminoglycoside	Condition			Dosage		Comments
A. Loading Doses	—To be given once initially—See Section C for determining when to
use actual body weight (ABW) and lean body weight (LBW)
Gentamicin/ Tobramycin	Non-head injured Head injured Uncomplicated urinary tract infection			2.5-3 mg/kg ABW 2-2.5 mg/kg ABW 2 mg/kg LBW		Expected peak concentrations: 6-8 mg/L
Amikacin	Non-head injured Head injured Uncomplicated urinary tract infection			10-12 mg/kg ABW 8-10 mg/kg ABW 8 mg/kg LBW		Expected peak concentration: 25-35 mg/L
B. Maintenance Doses—See Section C for determining when to use actual body weight (ABW) and lean body weight (LBW) and how to determine dosing interval
Gentamicin/ Tobramycin	Non-head injured Head injured Uncomplicated urinary tract infection			1.8-2 mg/kg ABW at selected interval 1.5-1.8 mg/kg ABW at selected interval 1 mg/kg LBW at selected interval		Expected peak concentrations: 6-8 mg/L Due to the high concentrations of drug excreted into the urine, allowing lower dose therapy, routine monitoring of serum concentrations in uncomplicated urinary tract infections may not be required
Amikacin	Non-head injured Head injured Uncomplicated urinary tract infection			7.5-8 mg/kg ABW at selected interval 6-7.5 mg/kg ABW at selected interval 4 mg/kg LBW at selected interval		Expected peak concentration: 25-35 mg/L Due to the high concentration of drug excreted into the urine, routine monitoring of serum concentrations in uncomplicated urinary tract infections may not be required
C. Determining Aminoglycoside Dosing Weights and Dosing Intervals
Calculating Aminoglycoside Dose
Use actual body weight to determine the dose for infections in critically ill patients. Use lean body weight to determine the dose for treating urinary tract infections.
Calculating Lean Body Weight (kg) Males: 50 kg + [(2.3 kg) x (inches >5 feet)]
Females: 45.5 kg + [(2.3 kg) x (inches >5 feet)]
C. xác định liều Aminoglycoside theo cân nặng và khoảng cách dùng 1. tính độ thanh thải creatinine (CrCl). 2. tính độ thanh thải mỗi 4-, 12-, or 24-h 3. tính độ thanh thải creatinine( ml/min) sử dụng công thức Cockcroft và Gault:
Males: (140-age) LBW 72 × SCr			Females: 0.85 × male CrCl
tính liều duy trì
Creatinine Clearance (ml/min)			khoảng cách dùng liều
>160 100–159 60–99 40–59 <40			q8h q8–12h q12–18h q18–24h q24–48h
II. liều đơn or liều cao
1 số bác sĩ lâm sàng thích dung liều 1 lần với chức năng thậnb ình thường nhưng còn tranh cãi
thuốc		liều			Chú ý
Gentamicin		5–8 mg/kg ABW			truyền trong 60 p hút nồng độ đỉnh mong đợi: 20–25 mg/L nồng độ mong muốn trước khi chuyển liều tiếp: 0 mg/L
Amikacin		20–32 mg/kg ABW			truyền trong 60 min nồng độ đỉnh mong đợi: 80–100 mg/L nồng độ mong muốn trước khi chuyển liều tiếp : 0 mg/L
khoảng cách liều duy trì
Creatinine Clearance (ml/min)				khoảng cách liều
>110 81–110 60–80 <60				q24h q36h q48h theo nồng độ