What is Hartford nomogram?

The Hartford Nomogram method utilizes high-dose, once daily dosing to optimize the peak/MIC ratio in most clinical situations by administering a dose of 7mg/kg of either gentamicin or tobramycin.

What is dosing nomogram?

A nomogram is presented for the rapid determination of the dosage adjustment factor for drugs eliminated in part by the kidneys in patients with reduced renal function.

What is the evidence for once daily aminoglycoside therapy?

Extensive recent evidence from in vitro, animal and human studies suggests that these target concentrations need revision. Aminoglycosides display concentration-dependent bacterial killing, have a long postantibiotic effect, and induce adaptive resistance in Gram-negative bacteria.

How does the once daily dosing affect aminoglycoside toxicity?

Although once-daily dosing of aminoglycosides may result in a period of up to 12 h during which there are no detectable serum concentrations of the drug, the post-antibiotic effect of the aminoglycosides allows for once-daily dosing without compromising therapeutic efficacy.

When do you use the Hartford nomogram?

The 7 mg/kg dose uses the Hartford nomogram for interval adjustment. If patient is started on either gentamicin or tobramycin and has a UTI, open fracture/surgery prophylaxis, cystitis, wound infections, pyelonephritis, or intraabdominal/pelvic infection, 5 mg/kg is warranted.

What is Young’s rule?

Young’s Rule is an equation used to calculate pediatric medication dosage based on the patient’s age and the known recommended adult dose. The definition of Young’s Rule is the age of the patient, divided by the age added to twelve, all multiplied by the recommended adult dose.

Why aminoglycosides are given once-daily?

Although administration of multiple daily doses remains the standard method of aminoglycoside dosing, once-daily dosing may provide enhanced clinical efficacy and reduced toxicity in selected patient populations; demonstrated pharmacokinetic and pharmacodynamic advantages include enhanced postantibiotic effect and an …

Which is an aminoglycoside?

The aminoglycosides are broad-spectrum, bactericidal antibiotics that are commonly prescribed for children, primarily for infections caused by Gram-negative pathogens. The aminoglycosides include gentamicin, amikacin, tobramycin, neomycin, and streptomycin.

How can you reduce aminoglycoside toxicity?

To minimize the risk of nephrotoxicity, select loading and maintenance aminoglycoside dosages based on estimated creatinine clearance. Also, monitor peak and trough serum aminoglycoside levels, replenish volume, and correct potassium and magnesium abnormalities.

When to use Hartford nomogram for gentamicin?

If the patient is started on either gentamicin or tobramycin and has a suspected Pseudomonas infection, pneumonia, osteomyelitis, meningitis, or sepsis, 7 mg/kg is used to calculate the initial dose. The 7 mg/kg dose uses the Hartford nomogram for interval adjustment.

Which is the best nomogram for aminoglycoside clearance?

The Urban-Craig nomogram was developed with an option for Q12h dosing, which is especially useful in younger patients with high aminoglycoside clearance who may have an inappropriately long interval of subtherapeutic drug levels.

What are the dosing guidelines for aminoglycoside therapy?

Dosing for Aminoglycoside High Dose Extended Interval Method Drug Cr Cl or eGFR ≥ 60 ml/min Cr Cl or eGFR 40 – 59 ml/min Gentamicin Tobramycin 5- 7 mg /kg INT-Q24H (round dose to the nearest 10mg) 5-7 mg/kg INT-Q 36 – 48H (round dose to the nearest 10mg) Amikacin 15 -20 mg/kg INT-Q24H (round dose to the nearest 50mg increment)

When to take aminoglycoside before or after infusion?

It’s recommended to obtain a random serum level 6 to 14 hours (for Hartford nomogram) and 8 to 12 hours (for Barnes-Jewish nomogram) after the start of the initial infusion. The resultant level is then plotted on the nomogram, in which optimal dosing interval can be determined.