Low
NA
$26.70/day
| Height | Males | Females |
|---|---|---|
| 150.0 cm | 50.0 kg | 45.5 kg |
| 152.5 cm | 52.3 kg | 47.8 kg |
| 155.0 cm | 54.6 kg | 50.1 kg |
| 157.5 cm | 56.9 kg | 52.4 kg |
| 160.0 cm | 59.2 kg | 54.7 kg |
| 162.5 cm | 61.5 kg | 57.0 kg |
| 165.0 cm | 63.8 kg | 59.3 kg |
| 167.5 cm | 66.1 kg | 61.6 kg |
| 170.0 cm | 68.4 kg | 63.9 kg |
| 172.5 cm | 70.7 kg | 66.2 kg |
| 175.0 cm | 73.0 kg | 68.5 kg |
| 177.5 cm | 75.3 kg | 70.8 kg |
| 180.0 cm | 77.6 kg | 73.1 kg |
| 182.5 cm | 79.9 kg | 75.4 kg |
| 185.0 cm | 82.2 kg | 77.7 kg |
| 187.5 cm | 84.5 kg | 80.0 kg |
| 190.0 cm | 86.8 kg | 82.3 kg |
Serum creatinine whenever initiating any aminoglycoside.
Creatinine and trough level should be monitored AT LEAST twice weekly; more often if unstable renal function or addition
of nephrotoxic medications.
Order appropriate trough level for dosage regimen used
Once Daily/Extended Interval Dosing
Order 6 hour pre-dose level
Target level: less than 1 mg/L
Multiple Daily Dosing
Order tobramycin trough level (0-60 min before a dose)
Desired result: less than 2 mg/L
Tobramycin Peaks
Are not used in once daily/extended interval regimens
For multiple daily dosing regimens, Peaks not commonly measured but if required are collected 30-60 min after dose infused
Nephrotoxicity
Avoid concomitant nephrotoxins
Less common with once daily dosing
Greater toxicity with longer duration and supratherapeutic trough levels
KEEP DURATION TO MINIMUM POSSIBLE FOR INDICATION BEING TREATED
Vestibulocochlear toxicity
Irreversible
Require audiology testing if prolonged use
Other
Can exacerbate neuromuscular blockade
Contraindicated in patients with myasthenia gravis.
Increased nephrotoxicity
Amphotericin B
Cyclosporine
Cisplatin
NSAIDS
Contrast dye
Vancomycin
Increased ototoxicity
Neuromuscular blockade agents - Respiratory paralysis.
IV: N/A
Nebules: generic are open benefit
TOBI brand require Special Authorization (CF)
IV Administration
Dilute in 100 mL D5W or NS and administer over 30-60 min. (*60 min for extended interval dosing)
EH Prescribing Restrictions
None (Pharmacist review of therapy)
Community IV Formulary (Metro area
YES
See EH Intranet for Full Aminoglycoside dosing policy:
PHA-124: Aminoglycoside Antibiotic Monitoring (Adult)
Antimicrobial class: Aminoglycoside
Pregnancy category: D
Average serum half life: 3 hours
Urine penetration: Therapeutic
Lung penetration: Therapeutic
CSF penetration: Poor
Biliary penetration: Moderate
Route of Elimination: Renal
