Evaluation of Four Once‐Daily Aminoglycoside Dosing Nomograms

Abstract

Once-daily aminoglycoside dosing using the four nomograms resulted in inaccurate dosing, and because of the large variability in human pharmacokinetics, dosing nomograms such as these should be abandoned in favor of individualizing dosages with therapeutic drug monitoring.

Therapeutic drug monitoring of once daily tobramycin in cystic fibrosis—caution with trough concentrations

“…Nomograms result in inaccurate dosing and should be abandoned in favour of individualised dosing [17].…”

Optimizing Antibiotic Pharmacodynamics for Clinical Practice

“…An alternate approach to a nomogram designed dose is to employ individualized dosing in specific patients based on the results of multiple serum concentrations, the resulting or estimated peak concentration and the MIC of the pathogen [48,49]. Although this provides a highly individualized and accurate approach, this may be time-consuming and burdensome in some hospitals if applied to all patients.…”

The Use of Extended-Interval Aminoglycoside Dosing Strategies for the Treatment of Moderate-to-Severe Infections Encountered in Critically Ill Surgical Patients

“…Until the late 1990's, use of the Hartford nomogram in critically ill surgical patients had not been evaluated [72][73][74][75][76][77][78][79]. Coupled by the widespread use of this nomogram and evidence supporting clinically meaningful changes in Vd in these patients, recent investigations determined the populationspecific pharmacokinetic behavior of this extended-interval nomogram.…”

“…(Level 2) 1a. Efficient and accurate estimation of aminoglycoside pharmacokinetics is reasonable using two measurable plasma concentrations obtained after the first dose and at least 6-8 h apart (e.g., 3-and 10-h postdose concentrations Rationale: Intra-and inter-patient variability in aminoglycoside clearance have also been demonstrated in critically ill surgical patients [14,72,73,[76][77][78][79]. Insufficient clearance is dealt with routinely by standard pharmacokinetic analysis and corresponding dose or interval adjustment(s).…”