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Volume of distribution eqn (non-obese pts)
0.25 L/kg (use IBW)
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Volume of distribution eqn (obese pts = >30% above IBW)
0.25 L/kg (IBW) + 0.1(TBW-IBW)
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Cmax for Life Threatening infections (meningitis, bacteremia, PNA)
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Cmax for serious infections (pyelo, abdominal, peritonitis)
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Goal troughs
- G/T < 2 mcg/mL
- A < 8 mcg/mL
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Dosing Interval for CrCl >= 60 mL/min
Every 8 hours
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Dosing Interval for CrCl 40-59 mL/min
Every 12 hours
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Dosing Interval for CrCl 20-39 mL/min
Every 24 hours
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Dosing Interval for CrCl < 20 mL/min
Give a loading dose then monitor levels
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Dosing Interval for HD
give dose after HD if concentration is less than 2 mcg/mL
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Dosing Interval for CRRT/CVVHD
Every 24-48 hours
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If an elevated peak what to do
reduce the dose (only for conventional dosing)
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IF an elevated trough what to do
extend the interval (only for conventional dosing)
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When to draw a steady state level
After 3rd dose (only for conventional dosing)
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HD Dosing
- 1-2 mg/kg
- Same wt used as for conventional dosing (Actual, IBW, ABW)
- Only dose if level after HD is <2 mcg/mL
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Once daily dosing for G/T and A
- 5-7 mg/kg q 24 hrs
- 15-20 mg/kg q 24 hrs
- Use actual wt unless obese then use adjusted
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Goal Peak for once daily dosing
- Use Cmax:MIC ratio (10:1)
- G/T: 20-30 mcg/mL
- A: 60-70 mcg/mL
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When to repeat a level for once daily dosing
- SCr increases by > 0.5 mg/dL or 50% from baseline
- Patient fluid status significantly changes
- Monitor every 5 days
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Exclusion Criteria for once daily dosing
- Acute Spinal Cord injury
- Ascites
- Burns over 20% BSA
- CrCl < 30 mL/min or on HD
- Endocarditis
- Febrile neutropenia
- Menigitis
- Pediatrics
- Pregnancy
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AG PK in gram-positive infections
- Conventional dosing
- Goal peak: 3-5 mcg/mL
- Goal trough: <2 mcg/mL
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