Aminoglycoside Calculator
Gentamicin, Tobramycin & Amikacin Pharmacokinetics
Estimated Patient Parameters
CrCl
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Dosing Weight
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Population Ke
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Population Vd
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Empiric Dosing
Extended Interval
| Target | Exact Dose | Gent/Tobra (20) | Amikacin (125) |
|---|---|---|---|
| Enter patient info to calculate | |||
Recommended Interval:
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Conventional
| Target | Exact Dose | Gent/Tobra (20) | Amikacin (125) |
|---|---|---|---|
| Enter patient info to calculate | |||
Recommended Interval:
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PK Level Revision & Regimen Testing
Calculate true patient kinetics using two levels (Sawchuk-Zaske) and test potential regimens.
1. Entry Parameters
2. Patient Specific Kinetics
True Ke
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True T1/2
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Calculated τ (5x T1/2)
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Model Used
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True Vd
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True Clearance
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Target --hr Dose to Achieve AUC24
Dose required per interval to achieve the daily AUC target.
AUC 70
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AUC 200
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AUC 100
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AUC 300
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3. Test Regimen
Expected Peak:
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Expected Trough:
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AUC 24hr:
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Peak / MIC:
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AUC24hr / MIC:
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Therapeutic Drug Monitoring Goals
Extended Interval
| Target | Peak | AUC24 |
|---|---|---|
| Gent/Tobra (4-7 mg/kg) |
20-25 | 70-100 |
| Gent/Tobra (10 mg/kg - CF) |
20-30 | -- |
| Amikacin (15 mg/kg) |
35-50 | 200-300 |
| Amikacin (20 mg/kg - CF) |
40-60 | -- |
Traditional Dosing
| Drug | Peak | Trough |
|---|---|---|
| Gent/Tobra | 4-8 (or 10x MIC) |
< 1-2 |
| Amikacin | 20-35 | < 5-8 |
Gram-Positive Synergy
| Gent/Tobra Dose | Peak | Trough |
|---|---|---|
| 1 mg/kg Q8H | 3-5 | < 1 |
| 3 mg/kg Q24H | N/A | < 1 |
References
- Winter ME. Basic Clinical Pharmacokinetics Fourth Edition. Lippincott Williams & Wilkins. Philadelphia. 2004; 19,131-171, 451-76.
- Rybak MJ, Abate BJ, Kang SL, Ruffing MJ, Lerner SA, Drusano GL. Prospective evaluation of the effect of an aminoglycoside dosing regimen on rates of observed nephrotoxicity and ototoxicity. Antimicrob Agents Chemother. 1999;43(7):1549-55.
- Barclay ML, Kirkpatrick CM, Begg EJ. Once daily aminoglycoside therapy. Is it less toxic than multiple daily doses and how should it be monitored?. Clin Pharmacokinet. 1999;36(2):89-98.
- Baddour LM, Wilson WR, Bayer AS, etal. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications (AHA). Circulation. 2005 Jun 14;111(23):e394-434
- Nicolau DP, et al. Experience with a once-daily aminoglycoside program administered to 2,184 adult patients. Antimicrob Agents Chemother 1995; 39(3):650-5.
- Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A.; Acute Kidney Injury Network. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury.Crit Care. 2007;11(2):R31.
- Barclay ML, Begg EJ, Hickling KG. What is the evidence for once-daily aminoglycoside therapy? ClinPharmacokinet. 1994 Jul;27(1):32-48.
- Brasseur A, Hites M, Roisine S, et al, A high-dose aminoglycoside regimen combined with renal replacement therapy for the treatment of MDR pathogens: a proof-of-concept study, Journal of Antimicrobial Chemotherapy. 2016;71(5):1386-1394.
- Roger C, Wallis SC, Muller L, et al. Influence of Renal Replacement Modalities on Amikacin Population Pharmacokinetics in Critically Ill Patients on Continuous Renal Replacement Therapy. Antimicrob Agents Chemother. 2016;60(8):4901-4909.
- Hoff BM, Maker JH, Dager WE, Heintz BH. Antibiotic Dosing for Critically Ill Adult Patients Receiving Intermittent Hemodialysis, Prolonged Intermittent Renal Replacement Therapy, and Continuous Renal Replacement Therapy: An Update. Ann Pharmacother. 2020 Jan;54(1):43-55.