Aminoglycosides - Revision history

Aidan at 18:46, 11 January 2024

2024-01-11T18:46:29Z

← Older revision		Revision as of 18:46, 11 January 2024
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	*Good coverage of Gram-negative aerobes		*Good coverage of Gram-negative aerobes
	**Except Stenotrophomonas and Burkholderia		**Except [[Stenotrophomonas]] and [[Burkholderia]]
	*Streptomycin also covers mycobacterium		*[[Streptomycin]] also covers mycobacterium
	*Some protozoal coverage		*Some protozoal coverage
	*Can cover Gram-positives if cell wall is disrupted (e.g. by beta-lactam)		*Can cover Gram-positives if cell wall is disrupted (e.g. by beta-lactam)
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	*Q8H dosing		*Q8H dosing
	*Used for [[Enterococcus]] IE, [[meningitis]], [[septic shock]], [[ascites]], [[AKI]]/[[CKD]], [[pregnancy]], surgical prophylaxis, [[Burn infection\|burns]], [[osteomyelitis]]		*Used for [[Enterococcus]] IE, [[meningitis]], [[septic shock]], [[ascites]], [[AKI]]/[[CKD]], [[pregnancy]], surgical prophylaxis, [[Burn infection\|burns]], [[osteomyelitis]]
	*1.~~7mg~~/kg (5-7.~~5mg~~/kg amikacin) IV q8h		*1.7 mg/kg (5-7.5 mg/kg [[amikacin]]) IV q8h

	===Extended Interval Dosing===		===Extended Interval Dosing===

	*Q24H dosing, which is safer but less well-studied		*Q24H dosing, which is safer but less well-studied
	*~~7mg~~/kg (~~15mg~~/kg amikacin) IV, frequency depends on [[CrCl]]		*7 mg/kg (15 mg/kg [[amikacin]]) IV, frequency depends on [[CrCl]]
	**[[CrCl]] ≥60 q24h		**[[CrCl]] ≥60 q24h
	**[https://www.mdcalc.com/creatinine-clearance-cockcroft-gault-equation CrCl] 40-59 q36h		**[https://www.mdcalc.com/creatinine-clearance-cockcroft-gault-equation CrCl] 40-59 q36h
	**[https://www.mdcalc.com/creatinine-clearance-cockcroft-gault-equation CrCl] 20-39 q48h		**[https://www.mdcalc.com/creatinine-clearance-cockcroft-gault-equation CrCl] 20-39 q48h
	**[https://www.mdcalc.com/creatinine-clearance-cockcroft-gault-equation CrCl] ≤19 don't use		**[https://www.mdcalc.com/creatinine-clearance-cockcroft-gault-equation CrCl] ≤19 don't use
	*Use Hartford nomogram with a random level (but remember to halve the [[amikacin]] level first)		*Use [[Hartford nomogram]] with a random level (but remember to halve the [[amikacin]] level first)

	===Dialysis Dosing===		===Dialysis Dosing===
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	===Synergy===		===Synergy===

	*~~1mg~~/kg divided q8-12h, peak target 3-5, trough <2		*1 mg/kg divided q8-12h, peak target 3-5, trough <2

	===Monitoring===		===Monitoring===

Aidan: Text replacement - " species]]" to "]]"

2022-02-15T18:32:32Z

Text replacement - " species]]" to "]]"

← Older revision		Revision as of 18:32, 15 February 2022
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	==Background==		==Background==

	*Derived from [[Streptomyces ~~species~~]] (mycins & kacins) or [[Micromonospora ~~species~~]] (micins)		*Derived from [[Streptomyces]] (mycins & kacins) or [[Micromonospora]] (micins)

	===Mechanism of Action===		===Mechanism of Action===

Aidan: /* Hartford Nomogram */

2020-10-18T23:11:15Z

Hartford Nomogram

← Older revision		Revision as of 23:11, 18 October 2020
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	===Initial Dose===		===Initial Dose===

	* If actual body weight more than 20% higher than [https://www.mdcalc.com/ideal-body-weight-adjusted-body-weight ideal body weight], need to calculate [https://www.mdcalc.com/ideal-body-weight-adjusted-body-weight adjusted body weight] (ABW)		*If actual body weight more than 20% higher than [https://www.mdcalc.com/ideal-body-weight-adjusted-body-weight ideal body weight], need to calculate [https://www.mdcalc.com/ideal-body-weight-adjusted-body-weight adjusted body weight] (ABW)

	$$ABW = IBW + 0.4 \times (actual BW - IBW)$$		$$ABW = IBW + 0.4 \times (actual BW - IBW)$$
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	[[File:Hartford_nomogram.png]]		[[File:Hartford_nomogram.png]]

			*Dosing interval is whichever is the line just above the random level
	*Double the concentration for [[amikacin]]		*Double the concentration for [[amikacin]]

Aidan at 22:44, 18 October 2020

2020-10-18T22:44:26Z

← Older revision		Revision as of 22:44, 18 October 2020
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	<br />

	==Background==		==Background==

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	*Altered 50S ribosomal subunit		*Altered 50S ribosomal subunit
	*Decreased uptake and accumulation (Pseudomonas)		*Decreased uptake and accumulation ([[Pseudomonas]])
	*Decreased membrane permeability		*Decreased membrane permeability
	*Efflux (E. coli)		*Efflux pump ([[Escherichia coli]])
	*Aminoglycoside-modifying enzymes (Enterococcus)		*Aminoglycoside-modifying enzymes ([[Enterococcus]])

	===Pharmacokinetics and Pharmacodynamics===		===Pharmacokinetics and Pharmacodynamics===
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	===Initial Dose===		===Initial Dose===

	If actual body weight more than 20% higher than [https://www.mdcalc.com/ideal-body-weight-adjusted-body-weight ideal body weight], need to calculate [https://www.mdcalc.com/ideal-body-weight-adjusted-body-weight adjusted body weight] (ABW)		* If actual body weight more than 20% higher than [https://www.mdcalc.com/ideal-body-weight-adjusted-body-weight ideal body weight], need to calculate [https://www.mdcalc.com/ideal-body-weight-adjusted-body-weight adjusted body weight] (ABW)

	$$ABW = IBW + 0.4 \times (actual BW - IBW)$$		$$ABW = IBW + 0.4 \times (actual BW - IBW)$$
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	===Traditional Dosing===		===Traditional Dosing===

			*Q8H dosing
	*Used for [[Enterococcus]] IE, [[meningitis]], [[septic shock]], [[ascites]], [[AKI]]/[[CKD]], [[pregnancy]], surgical prophylaxis, [[Burn infection\|burns]], [[osteomyelitis]]		*Used for [[Enterococcus]] IE, [[meningitis]], [[septic shock]], [[ascites]], [[AKI]]/[[CKD]], [[pregnancy]], surgical prophylaxis, [[Burn infection\|burns]], [[osteomyelitis]]
	*1.7mg/kg (5-7.5mg/kg amikacin)		*1.7mg/kg (5-7.5mg/kg amikacin) IV q8h

	===Extended Interval Dosing===		===Extended Interval Dosing===

			*Q24H dosing, which is safer but less well-studied
	*7mg/kg (15mg/kg amikacin)		*7mg/kg (15mg/kg amikacin) IV, frequency depends on [[CrCl]]
⚫	*Use Hartford nomogram with a random level (but remember to halve the amikacin level first)
	*[[CrCl]] ≥60 q24h		**[[CrCl]] ≥60 q24h
	*[https://www.mdcalc.com/creatinine-clearance-cockcroft-gault-equation CrCl] 40-59 q36h		**[https://www.mdcalc.com/creatinine-clearance-cockcroft-gault-equation CrCl] 40-59 q36h
	*[https://www.mdcalc.com/creatinine-clearance-cockcroft-gault-equation CrCl] 20-39 q48h		**[https://www.mdcalc.com/creatinine-clearance-cockcroft-gault-equation CrCl] 20-39 q48h
	*[https://www.mdcalc.com/creatinine-clearance-cockcroft-gault-equation CrCl] ≤19 don't use		**[https://www.mdcalc.com/creatinine-clearance-cockcroft-gault-equation CrCl] ≤19 don't use
		⚫	*Use Hartford nomogram with a random level (but remember to halve the [[amikacin]] level first)

	===Dialysis Dosing===		===Dialysis Dosing===
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	====Peak====		====Peak====

	*~~30min~~ after third dose		*30 minutes after third dose
	*Response is based on peak:MIC ratio, target is 8-10 times		*Response is based on peak:MIC ratio, target is 8-10 times
	*If below target, increase dose		*If below target, increase dose
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	====Trough====		====Trough====

	*Prior to 4th dose, or a random level at 24-48h in renal failure		*Prior to 4th dose, or a random level at 24 to 48h in renal failure
	*Side effects are predicted by trough levels		*Side effects are predicted by trough levels
	*~~Tobra~~ <0.5 (extended) or <2 (traditional)		*[[Tobramycin]] <0.5 (extended) or <2 (traditional)
	*Amikacin <1 (extended) or <?? (traditional)		*[[Amikacin]] <1 (extended) or <?? (traditional)
	*If above target, increase interval		*If above target, increase interval

Aidan: /* Extended Interval Dosing */

2020-10-18T22:39:53Z

Extended Interval Dosing

← Older revision		Revision as of 22:39, 18 October 2020
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	*7mg/kg (15mg/kg amikacin)		*7mg/kg (15mg/kg amikacin)
	*Use Hartford nomogram with a random level (but remember to halve the amikacin level first)		*Use Hartford nomogram with a random level (but remember to halve the amikacin level first)
	*CrCl ≥60 q24h		*[[CrCl]] ≥60 q24h
			*[https://www.mdcalc.com/creatinine-clearance-cockcroft-gault-equation CrCl] 40-59 q36h
	*CrCl 40-59 q36h
			*[https://www.mdcalc.com/creatinine-clearance-cockcroft-gault-equation CrCl] 20-39 q48h
	*CrCl 20-39 q48h
	*CrCl ≤19 don't use		*[https://www.mdcalc.com/creatinine-clearance-cockcroft-gault-equation CrCl] ≤19 don't use

	===Dialysis Dosing===		===Dialysis Dosing===

Aidan: /* Dosing */

2020-10-18T22:37:58Z

Dosing

← Older revision		Revision as of 22:37, 18 October 2020
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	===Initial Dose===		===Initial Dose===

	If actual body weight more than 20% higher than ideal body weight, need to calculate adjusted body weight (ABW)		If actual body weight more than 20% higher than [https://www.mdcalc.com/ideal-body-weight-adjusted-body-weight ideal body weight], need to calculate [https://www.mdcalc.com/ideal-body-weight-adjusted-body-weight adjusted body weight] (ABW)

	$$ABW = IBW + 0.4 \times (actual BW - IBW)$$		$$ABW = IBW + 0.4 \times (actual BW - IBW)$$
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	===Traditional Dosing===		===Traditional Dosing===

	*Used for Enterococcus IE, meningitis, septic shock, ascites, AKI/CKD, pregnancy, surgical prophylaxis, burns, osteomyelitis		*Used for [[Enterococcus]] IE, [[meningitis]], [[septic shock]], [[ascites]], [[AKI]]/[[CKD]], [[pregnancy]], surgical prophylaxis, [[Burn infection\|burns]], [[osteomyelitis]]
	*1.7mg/kg (5-7.5mg/kg amikacin)		*1.7mg/kg (5-7.5mg/kg amikacin)

Aidan: /* Traditional Dosing */

2020-09-18T19:21:53Z

Traditional Dosing

← Older revision		Revision as of 19:21, 18 September 2020
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	<br />		<br />

	== Background ==		==Background==

	*Derived from [[Streptomyces species]] (mycins & kacins) or [[Micromonospora species]] (micins)		*Derived from [[Streptomyces species]] (mycins & kacins) or [[Micromonospora species]] (micins)
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	===Traditional Dosing===		===Traditional Dosing===

	*Used for Enterococcus IE, meningitis, septic shock, ascites, AKI/CKD, ~~prefnancy~~, surgical prophylaxis, burns, osteomyelitis		*Used for Enterococcus IE, meningitis, septic shock, ascites, AKI/CKD, pregnancy, surgical prophylaxis, burns, osteomyelitis
	*1.7mg/kg (5-7.5mg/kg amikacin)		*1.7mg/kg (5-7.5mg/kg amikacin)

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	*1mg/kg divided q8-12h, peak target 3-5, trough <2		*1mg/kg divided q8-12h, peak target 3-5, trough <2

	=== Monitoring ===		===Monitoring===

	====Peak====		====Peak====
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	[[File:Hartford_nomogram.png]]		[[File:Hartford_nomogram.png]]

	* Double the concentration for [[amikacin]]		*Double the concentration for [[amikacin]]

	== Safety ==		==Safety==

	===Adverse Drug Reactions===		===Adverse Drug Reactions===

Aidan at 22:51, 29 August 2020

2020-08-29T22:51:05Z

Show changes

Aidan: /* Peak */

2019-12-16T15:17:54Z

Peak

← Older revision		Revision as of 15:17, 16 December 2019
Line 33:		Line 33:
	=== Peak ===		=== Peak ===

	* 30min after third? dose		* 30min after third dose
	* Response is based on peak:MIC ratio, target is 8-10 times		* Response is based on peak:MIC ratio, target is 8-10 times
	* If below target, increase dose		* If below target, increase dose

Aidan: /* Hartford Nomogram */

2019-12-16T15:17:02Z

Hartford Nomogram

← Older revision		Revision as of 15:17, 16 December 2019
Line 48:		Line 48:

	[[File:Hartford_nomogram.png]]		[[File:Hartford_nomogram.png]]

			Double the concentration for [[amikacin]]

	== Origin ==		== Origin ==