Maintenance dose nomogram for traditional, intermittent dosing of gentamicin and tobramycin in adults*

Creatinine clearance^¶ conventional unit (mL/minute)	Creatinine clearance^¶ SI unit (mL/second)	Maintenance dose (percent of loading dose^Δ)	Dose interval (hours)
>90	>1.5	84	8
80 to 90	1.3 to 1.5	80	8
70 to 79	1.2 to <1.3	76	8
60 to 69	1 to <1.2	84	12
50 to 59	0.8 to <1	79	12
40 to 49	0.7 to <0.8	72	12
30 to 39	0.5 to <0.7	86	24
20 to 29	0.33 to <0.5	75	24 to 36
<20^◊	<0.33^◊

SI: International System of Units.
* For many patients, the preferred dosing strategy is extended-interval. Refer to the aminoglycosides topic discussion of selection of dosing strategy. Although the dosing adjustments listed in this table should be applicable for amikacin dosing, they have not been validated for use with that agent.
¶ Creatinine clearance may be estimated using the Cockcroft-Gault equation. Calculators for estimation of creatinine clearance are available in UpToDate.
Δ Loading dose recommendations are provided in a separate table.
◊ When the creatinine clearance is below 20 mL/min, a loading dose is recommended, with subsequent doses guided by monitoring of the serum aminoglycoside concentration.

This table lists dosing adjustments recommended by UpToDate contributors based on pharmacokinetic data and institutional experience.

Graphic 57375 Version 8.0

خرید پکیج

Maintenance dose nomogram for traditional, intermittent dosing of gentamicin and tobramycin in adults*