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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.
Patients at risk of toxicity
- 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 including ICU.
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
Collect trough within one hour
of next dose
Peak levels: NA
Requires ID approval unless:
Febrile neutropenia or NICU SMO
|15mg/kg ONCE daily
Up to 20mg/kg ONCE daily (severe infection on consultation with ID team or as per protocol)
|Up to 30mg/kg ONCE
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|
> 1 month to 12 years
> 12 years
7mg/kg ONCE daily
5 - 7mg/kg ONCE daily
|10mg/kg ONCE daily
|Trough level: < 0.5 mg/L|
Requires ID approval unless CF protocol
|7mg/kg ONCE daily
|10mg/kg ONCE daily
|Trough level: < 1 mg/L|
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 if more than 72 hours of aminoglycoside is planned.
Do not withhold the next dose if waiting on a level (except in patients with renal impairment where dose will be withheld if trough is elevated).
If the patient is receiving a therapeutic dose and the level is less than the trough limits then continue same dose.
If the level is above trough limits and the 2nd dose was given, repeat the trough level before the 3rd dose, hold next dose until level is below trough limits. Repeat levels at 6 hourly intervals until trough is within range.
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).
Continue to monitor every 3-5 days thereafter or more frequently for at risk patients
New Zealand Formulary for Children v46 - 01 April 2016
Evelina London Paediatric Formulary, Evelina Children's Hospital, St Thomas' Hospital. July 2015.
BNF for Children 2011-2012
Taketomo C, Hodding JH, Kraus DM. Paediatric Dosage Handbook 17th Edition, Ohio Lexicomp Inc. 2010.
Red Book American Academy of Paediatrics 2015
Did you find this information helpful?
- Date last published: 06 March 2017
- Document type: Clinical Guideline
- Services responsible: Paediatric Infectious Diseases, ADHB Pharmacy
- Author(s): Caro de Luca, Emma Best, Roisin Daly, Natasha Pool
- Editor: Greg Williams
- Review frequency: 2 years
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