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A new pediatric pulmonologist at our facility wants to monitor "once-
daily" tobramycin dosing (10mg/kg) in a 17YO CF patient using a
target AUC derived from two levels at 2hrs and 6 hrs post infusion.
We have not done this previously at our facility, but I did find
limited information describing similar methodology on a lit search.
Does anyone out there have recommendations for practical software to
calculate AUC data from two random serum levels separated by a drug-
free interval?
I am also very interested in anyone's opinion regarding this approach
to tobramycin TDM. We have a demo version of kinetics software that
calculates AUIC if MIC data is available. Would this be a better
predictor of efficacy for aminoglycosides given the pharmacodynamic
properties of the drug class? (PAE, CDK).
Thanks all,
R. Timothy Gendron, RPh
Clinical Coordinator
Pharmacy Service Line
Naval Medical Center
Portsmouth, Virginia 23708
Office: (757) 953-0252
Fax: (757) 953-0863
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A easy program for the calculation od AUC values in different
situations
using different methods is the UNICUBE.
Although values of area under the inhibitory curve (AUIC) over 24 hours
of >125 has been proposed for beta-lactams, quinolones and
aminoglycosides the most frequent pharmacodynamic parameter used with
aminoglycosides is the Cmax/MIC ratio. A Cmax/MIC ratio of >10 are
frequently associated with clinical success for the aminoglycosides. In
the practice both PD parameters (Cmax/MIC ratio and AUIC) may be used to
evaluate clinical efficacy of aminoglycosides.
Regards,
Jose M. Lanao
Dpt. Pharmacy and Pharmaceutical technology
Faculty of Pharmacy
University of alamanca
Spain
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The following message was posted to: PharmPK
Take a look at the following citation for additional information.
Mouton, JW, et.al. Pharmacodynamics of tobramycin in pateints with
cystic fibrosis. Diagnostic Microbiology and Infectious Disease.
2005;52:123-27. Although a small study, it agrues against once daily
dosing.
Good luck,
Carlton
Carlton K.K. Lee, Pharm.D., MPH, FASHP
Clinical Specialist - Pediatrics
Program Director - Pediatric Residency
Department of Pharmacy
The Johns Hopkins Hospital
Assistant Professor - Pediatrics
Johns Hopkins University
Phone: (410) 614-2949
FAX: (410) 955-9765
email: cleea.-at-.jhmi.edu
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The following message was posted to: PharmPK
Hi
You could consider looking at these references
AUC calculated by hand-held calculator
Begg et al., A suggested approach to once-daily aminoglycoside dosing.
Br J Clin Pharmacol. 1995 Jun;39(6):605-9.
or using Bayesian Methods
Duffull et al Comparison of two Bayesian approaches to dose-
individualization for once-daily aminoglycoside regimens.
Br J Clin Pharmacol. 1997 Feb;43(2):125-35.
Kirkpatrick et al., The use of a change in gentamicin clearance as an
early predictor of gentamicin-induced nephrotoxicity.
Ther Drug Monit. 2003 Oct;25(5):623-30.
With kind regards
Carl
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The following message was posted to: PharmPK
We have developed a Nomogram for Tobramycin in CF based on a dose of
12mg/kg/day.
Currently under review for publication.
I would email a copy of the graph but not yet for public distribution
at present.
Regards,
Noel Cranswick
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