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Aminoglycosides

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Introduction

Patients excluded from these guidelines include those with renal impairment and endocarditis.

These doses apply only to full term newborns more than 4 weeks of age. Refer to Neonatal guidelines via Newborn Services website for infants < 4 weeks of age.

  • Baseline creatinine levels should be performed for all patients and repeated whenever levels are being checked (may be required more often if renal function is abnormal).
  • Therapeutic drug monitoring is mandatory in all cases except where a course duration <72 hours e.g. surgical prophylaxis.
  • Consider audiology testing (at baseline if possible as well as during and after) therapy in "at risk patients". If there is a family history of deafness acquired post antibiotic administration, consider other alternative antibiotic therapy.

At risk patients

  • Patients in whom drug administration has been ≥ 7 days
  • Patients on concomitant nephro / ototoxic drugs
  • Patients with renal impairment, changing renal function, or altered fluid balance.

CF patients

Discuss with the Respiratory Consultant before starting aminoglycosides in a CF patient.

Maximum doses apply to standard once daily dosing.

Children with cystic fibrosis require higher doses and usual maximums do not apply

Drug Standard ONCE daily dosing Cystic Fibrosis Dosing Administration Monitoring
Amikacin 15mg/kg ONCE daily

Up to 20mg/kg ONCE daily in severe infection on consultation with ID team or as per protocol

Max 1.5g/dose
Up to 30mg/kg ONCE daily




Dilute with sodium chloride 0.9% or glucose 5%
 
 

Give over 30 minutes as IV infusion
 
 

Refer to Guardrails administration guide via the reference viewer or pharmacy intranet site for further details
Trough level: <1 mg/L

CF trough level: <3mg/L

Peak level: N/A
Gentamicin 7mg/kg ONCE daily

Max 360mg/dose
10-12mg/kg ONCE daily


Trough level: < 0.5 mg/L

CF trough level: <1 mg/L

Peak level: N/A
Tobramycin 7mg/kg ONCE daily

Max 360mg/dose
10-12mg/kg ONCE daily


Trough level: < 1 mg/L

Peak level: N/A

Doses in Obese Children 

To avoid excessive dosing in obese children, use ideal body weight for height to calculate dose and monitor concentrations closely.

The 'Ideal Weight' for dose calculation purposes for an obese child may be approximated using standard growth charts (e.g. on CRIS or at www.cdc.gov/growthcharts/ )

  • If the age and height are known, a height growth chart will indicate the percentile at which to read the "ideal" weight from a weight growth chart.
  • If only the age is known, reading from the 50th percentile on a weight growth chart is a practical method for "ideal" weight estimation.

Monitoring & Adjusting Dosing Interval 

Take trough level immediately before the 2nd dose.

Do not withhold the next dose if waiting on a level (except in patients with significant renal impairment where you might withhold the dose if the level is elevated)

If the patient is receiving a therapeutic dose and the level is less than the trough limits then continue on same dose.

If the level is above trough limits and the 2nd dose was given, repeat the trough level before the 3rd dose and then keep repeating the level at 6hr intervals until the level is below trough limits.

The interval between the dose being given and a safe trough level should then become the new dosing interval (e.g. if trough level at 24 hours was high, but trough level at 30 hours was below the trough limit then give the dose every 30 hours).

If the trough level is above trough limits and the 2nd dose wasn't given, then keep repeating the level at 6hr intervals until the level is below trough limits. The interval between the dose being given and a level of < trough limits should then become the new dosing interval.

Continue to monitor every 3-5 days thereafter or more frequently for at risk patients

References

Royal Children's Hospital Melbourne Children's Hospital, Paediatric Pharmacopoeia, Pharmacy Department, Royal Children's

Hospital, Melbourne, 2002.Guy's, St. Thomas' and Lewisham Hospitals, Paediatric Formulary, 6th Edition, Guy's and St Thomas' Hospitals Trust, 2005.

BNF for Children 2011-2012

Taketomo C, Hodding JH, Kraus DM. Paediatric Dosage Handbook 17th Edition, Ohio Lexicomp Inc. 2010. 

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Document Control

  • Date last published: 01 September 2012
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Infectious Diseases, ADHB Pharmacy
  • Author(s): Caro de Luca, Emma Best, Roisin Daly
  • Editor: Greg Williams
  • Review frequency: 2 years

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