What is the dosing of aminoglycosides?
Clinical studies show at least equal effectiveness and no greater toxicity when compared with traditional regimens. A dose of 5-7 mg/kg of gentamicin, tobramycin, or netilmicin, with at least a 24 h dosing interval should be employed and a similar regimen can be applied to amikacin dosing.
Why are aminoglycosides contraindicated in patients with kidney failure?
Aminoglycosides are toxic to the kidney because a small, but appreciable, amount (estimated at 5% of the dose) is retained in the epithelial cells of the proximal tubule after renal elimination.
How do you administer aminoglycosides?
Because aminoglycosides are normally used to treat serious infections, they are typically administered into the veins of the body (intravenously, or IV). However, some aminoglycosides can be taken orally, or as ear or eye drops.
How do you give gentamicin on dialysis?
The current dosing guideline for gentamicin approved by the FDA is to administer half of the full dose immediately after each haemodialysis session. This dosing strategy has been challenged by several studies suggesting that a full dose of gentamicin given 1 h before the haemodialysis session would be more beneficial.
Why are aminoglycosides not given orally?
Aminoglycosides such as gentamicin cannot be administered orally for treatment of systemic infection because they are not absorbed from the intact gastrointestinal tract .
When do you need aminoglycoside levels?
Aiming for a level < 1 mcg/mL approximately 6-hours prior to the next dose ensures there is a drug-free window in order to minimize drug accumulation within the proximal tubules. Maintenance random levels should be monitored at least once weekly.
Which aminoglycoside is most Ototoxic?
It has long been known that the major irreversible toxicity of aminoglycosides is ototoxicity. Among them, streptomycin and gentamicin are primarily vestibulotoxic, whereas amikacin, neomycin, dihydrosterptomycin, and kanamicin are primarily cochleotoxic.
What is the most nephrotoxic aminoglycoside?
The choice of aminoglycoside is important in reducing nephrotoxicity. The following rank order of nephrotoxicity has been reported, from most toxic to least toxic: neomycin > gentamicin ≥ tobramycin ≥ amikacin ≥ netilmicin > streptomycin .
Why are Aminthlycosides not given in myasthenia gravis?
Aminoglycosides should be avoided in patients with myasthenia gravis because of the risk of prolonged neuromuscular blockade.
When is aminoglycoside used?
Aminoglycosides are used in the treatment of severe infections of the abdomen and urinary tract, as well as bacteremia and endocarditis. They are also used for prophylaxis, especially against endocarditis. Resistance is rare but increasing in frequency.
Why amikacin should not be used in renal failure?
Aminoglycoside-induced ototoxicity is usually irreversible. Aminoglycosides are potentially nephrotoxic. The risk of nephrotoxicity is greater in patients with impaired renal function and in those who receive high doses or prolonged therapy.
Is amikacin safe in renal failure?
Conclusion: Amikacin usage in described, lowered doses with prolonged interval between them is safe in terms of ototoxicity and nephrotoxicity in patients with chronic kidney disease. Every two days dosage is less effective than every day dosage in patients with stage 4 CKD.
What are the dosing guidelines for aminoglycoside therapy?
Dosing for Aminoglycoside High Dose Extended Interval Method Drug Cr Cl or eGFR ≥ 60 ml/min Cr Cl or eGFR 40 – 59 ml/min Gentamicin Tobramycin 5- 7 mg /kg INT-Q24H (round dose to the nearest 10mg) 5-7 mg/kg INT-Q 36 – 48H (round dose to the nearest 10mg) Amikacin 15 -20 mg/kg INT-Q24H (round dose to the nearest 50mg increment)
How much aminoglycoside should I take for Gram negative infection?
Dosing for Aminoglycoside High Dose Extended Interval Method For treatment of severe Gram-negative infections, dose recommended for gentamicin or tobramycin is 7 mg/kg and dose recommended for amikacin is 20mg/kg Use Total Body Weight (TBW) if Total Body Weight is less than 1.2 x Ideal Body Weight (IBW)
What are the dosing recommendations for peritoneal dialysis?
Intraperitoneal (IP) Administration of Antimicrobials Antimicrobial Intermittent Dosing (antibiotic added to 1 exchange per day; dwell at least 6 hours) Continuous Dosing (antibiotic added to all exchanges) Amikacin 2 mg/kg daily LD: 25 mg/L MD: 12 mg/L Ampicillin No data MD: 125 mg/L Ampicillin/ sulbactam 2 g q12 hours LD: 750-1000 mg/L
Which is better extended interval aminoglycosides or Eiad?
Dosing Extended interval aminoglycoside dosing (EIAD )is preferred over traditional dosing in patients that meet EIAD eligibility criteria. EIAD typically employs a daily dose of 7 mg/kg (5 mg/kg/day for UTI is reasonable) and is usually dosed q24h in patients with normal renal function. This approach is