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I have seen a few nomograms (e.g. Barnes-Jewish Hospital, N. Anaizi's
nomogram- each slightly different) for use with the 5 mg/kg dosing for
Gent/Tobra instead of the 7 mg/kg Nicolau nomogram. Are the nomograms
used with the 5 mg/kg dosing individually extrapolated for each
institution, or is there a referenced study showing the accuracy of a
different nomogram other than the 7mg/kg Nicolau nomogram?
Thanks,
Brian Bain
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The following message was posted to: PharmPK
Dear Mr. Bain,
There are a lot of nomograms concerning aminoglycosides' dosage
adjustment but all of them are insufficient in dealing with large
interindividual PK variability of aminoglycosides as well as with their
narrow therapeutic index.
According to my experience the nomograms are even misleading in
patients with unstable renal function changing over 24 hours. The best
way to cope the problem is TDM combined with Bayesian forecasting of
dosage regimens of aminoglycosides.
A reliable and easy-to-use for every day work in clinical setting is
USC*PACK collection of PC programs. I have personal experience with that
software and I strongly recommend it to you.
Kind regards,
Prof. Dimiter Terziivanov, MD,PhD
Clinic for Therapeutics and Clinical
Pharmacology, Univ Hosp "St. I.Rilsky",
15 D. Nestorov st, 1431 Sofia, Bulgaria
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Brian:
We are using a nomogram with proportional extrapolation based upon
Nicolau's 7mg/kg nomogram, but have included a q12h segment based upon
recommendations from Bill Craig, M.D. If in the q12h group, we include
the caveat that 2 point confirmation is appropriate.
Regarding your second question, I doubt you will see prospective trials
done that have adequate power to detect the small differences in
efficacy or toxicity associated with either the q12 vs q24h dosing
regimens, let alone the differences between q24h nomograms. Paul
Paul R. Hutson, Pharm.D.
Associate Professor (CHS)
UW School of Pharmacy
777 Highland Ave
Madison, WI 53705-2222
608/263.2496
FAX 608/265.5421
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Copyright 1995-2010 David W. A. Bourne (david@boomer.org)