Aminoglycosides:

Most flexible
Pharmacokinetic
dosing method For both: Conventional and
Extended interval

For Pt. with renal dysfunction or

Hull and Sarubbi Obesity
nomogram For Conventional dosing only
Setting initial Dose
Same as previous one, but
Hartford nomogram modified for Extended interval
dosing

Literature-based
For Paediatric patients
recommended dosing

Aminoglycosides

Linear Pharmacokinetics Because Antibiotics follow Linear

Method PK

Pharmacokinetic concepts
Can also change the dosing Interal
Method

Modifying the Dose Sawchuk-Zaske method

Area under curve Method

Bayesian pharmacokinetic
For difficult cases
computer programs
A. Setting Initial Dose:

1. Pharmacokinetic Dosing method:

1. Estimate CrCl:

a. When patient is not obese: Use Cockcroft - Gault equation:

CrCl = [(140 - age) x Wt] / (72 x SCr)

b. When patient is obese: Use Salazar and Corcoran equation :

CrCl male= [137 - age] x [(0.285 x Wt) + (12.1 x Ht(m)2)] / 51 x Scr

CrCl female= [146 - age] x [(0.287 x Wt) + (9.74 x Ht(m)2)] / 60 x Scr

2. Estimate Ke and T1/2 :

Ke= 0.00293(CrCl) + 0.014

T1/2 = 0.693/ke

3. Estimate volume of distribution:

a. Normally: Vd = 0.26 L/kg

b. Obese (i.e Wt is 30% greater than IBW) : Vd= 0.26[IBW + 0.4(TBW − IBW)] IBWm= 50+2.3(Ht”-60)
IBWf= 45+2.3(Ht”-60)

c. Overhydrated Pt: Vd= (0.26 x DBW) + (TBW − DBW)

d. Cystic fibrosis: Vd= 0.35L/Kg

4. Choose desired steady-state serum concentrations:

Condition G.N.T Amikacin

Conv

8-10 mcg/mL or 5-7mcg/mL (not

Gram –ve, Psedomonas, 25-30 mcg/mL or 15-25 mcg/mL
deep or intraabdominal )
Pneumonia, Cystic fibrosis
and Septicemia
Ezxt

20-30 mcg/mL NA
Cpss max

Conv

UTI, Endocarditis 3-5 mcg/mL 12-15 mcg/mL

Conv

Pyelonephritis 8-10 mcg/mL 25-30 mcg/mL

Conv

<2 mcg/mL 5-7 mcg/mL

Cpss min

Ext

<1 mcg/mL NA
5. Dosage interval (τ):

Bolus: τ = [(ln Cssmax − ln Cssmin) / ke]

Infusion: τ = [(ln Cssmax − ln Cssmin) / ke] + t′

6. Dose:

Bolus: D = Cssmax V(1 − e−keτ)

Infusion: k0 = Cssmax keV[(1 − e−keτ) / (1 − e−ket′)]

7. Compute loading dose (LD):

Bolus: LD = Cssmax x V

Infusion: LD = k0 / (1 − e−keτ)