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Aminoglycosides

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    公告日期：105-11-29       

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    Aminoglycosides
    Once-daily dosing and multiple-daily dosing of aminoglycosides are equal efficacy for pulmonary infections. It has been shown to be less nephrotoxic in children with cystic fibrosis.1 
    Most studies show no significant difference in nephrotoxicity with once-daily and conventional dosing. Nephrotoxicity is influenced by the duration of treatment and higher trough levels.2
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    Once daily dosing method

    ◎Step 1:先確定病患沒有符合以下任一項
    Exclusion criteria for once daily dose for aminoglycosides
    Ascites
    Dialysis
    Elderly (Age>70y/o)
    Endocarditis
    Extensive burns (>20% BSA)
    Pregnancy or post-partum
    Severe liver disease (Child B, C)
    Synergy for enterococcal infection
    Surgical prophylaxis
    Severe fluid overload state
    Renal insufficiency (Ccr< 30ml/min)
    History or signs of hearing loss or vestibular toxicity
    符合以上exclusion criteria for once daily dose的病患，請用conventional method. 其餘病患，請用once daily dose method
     

    ◎Step 2:確定病患用來計算藥物劑量的體重

    2Dosing will be based on actual body weight (AcBW) unless the patient is obese (AcBW > 120% IBW)

     

    ◎Step 3:把上述步驟所決定的體重，依照以下方式計算劑量

      Ccr>80 CCr 60-80 CCr 40-60 Ccr 30-40 CCr 20-30
    Gentamicin 5-7mg/kg qd 4 mg/kg qd 3.5 mg/kg qd 2.5 mg/kg qd 4 mg/kg qod
    Amikacin 15-20mg/kg qd 12 mg/kg qd 7.5 mg/kg qd 4 mg/kg qd 7.5 mg/kg qod

    ◎Step 4:使用後，請監測 gentamicin 或 amikacin 的藥物血中濃度 (trough level)
    Conventional method
      *Loading Dose **Maintenance Dose Target Serum Levels
    Gentamicin 2-2.5mg/kg 3-5mg/kg/day in 1-3 divided doses Peak-: 4-10
    Trough: 1-2
    Amikacin 7.5mg/kg 15mg/kg/day in1-2 divided doses Peak-: 15-30
    Trough: 5-10
    *Loading Dose：IBW or Adjusted body weight if obese
    **Maintainence dose: Computed dose X estimated Ccr/100 (若estimated Ccr>100，以100計算)
    Peak serum level may be measured 30 minutes after at the end of infusion the first conventional dose

     

      1Smith A, et al. Cochrane Database Syst Rev. 2014
      2Freeman C, et al. J of Antimicrob Chemo 1997
      3Sanford Guide Antimicrobial Therapy 2013
      4Mandell’s Principles and Practice of Infectious Diseases Seventh edition
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