CALCULATION OF AMINOGLYCOSIDE DOSE

1. Revise K and T :

1. Calculate CLcr and Aminoglycoside CL

C1
C2
K=
T
ln

CLAMG(L/hr) = CLcr(ml/min) (0.06)

rd

2. Estimate Vd; (account for obesity, 3 spaced fluid)

Normal Vd(L/Kg)
Obese (>130% IBW)
Fluid overload

AMINOGLYCOSIDE REVISIONS

= 0.25 L/Kg x Wt (kg)

= 0.25 (IBW) + 0.1 (TBW IBW)
= 0.25 (Dry weight) + 1 (kg wt gain)

3. Calculate elimination rate constant (Kel) and half-life (T )

T =

0.693
K

2. Determine Model
If 6 (tin) T then use BOLUS MODEL
If 6 (tin) > T then use INFUSION MODEL
3. Revise Vd and CL

CL
Kel =
Vd

0.693 (Vd )
T =
CL

Bolus Model

Dose
C1
e kt
Vd =
1 e K

4. Choose dosing model: bolus vs. short infusion

If 6 (tin) T then use BOLUS MODEL
If 6 (tin) > T then use INFUSION MODEL

Short Infusion Model

5. Select appropriate dosing interval () (usually 4-5 T s)

(12, 24, 48) In-vivo PAE ~ 10 hours
(Craig WA, et al. J Antimicrob Chemother 1991;27(SupplC):29-40)

6. Calculate Daily Dose based on AUC target (70-100 mg h/L)

Barclay M, et al. Aust NZ J Med 1995;25:230-5

Dose (mg/24 hrs) = 70 100 (CL); [Amikacin ~ 3x higher]

Dose
C t = Vd K e Kt
1 e
t = Time from start of dose

Trough = Peak e k t

Vd =

CL
K

4. Select appropriate dosing interval () (usually 4-5 T s)

5. Calculate Daily Dose based on AUC target (70-100 mg h/L)

6. Calculate expected peak and trough concentrations

Short Infusion Model

Dose / tin
1 e K ( tin )
C1
e Kt
CL =
K
1 e

Dose (mg/24 hrs) = 70 100 (CL); [Amikacin ~ 3x higher]

7. Calculate expected peak and trough concentrations

Bolus Model

CL = (K)(Vd)

Dose / tin
1 e K (tin )
CL
Ct =
e Kt
k
1 e
t = time from end of infusion

Bolus Model

Dose
C t = Vd K e Kt
1 e
t = Time from start of dose

Trough = Peak e k t

Short Infusion Model

Dose / tin
1 e K (tin )
CL
e Kt
Ct =
k
1 e
t = time from end of infusion

CALCULATION OF VANCOMYCIN DOSE

1. Calculate CLcr and Vancomycin CL

VANCOMYCIN REVISIONS
1. Revise K, T

CLVAN(L/hr) = CLcr(ml/min) (0.06)

2. Estimate Vd

= 0.7 (L/kg) * TBW (Kg)

Normal Vd(L) = 0.17 (Age) + 0.22 (TBW)

3. Calculate elimination rate constant (Kel) and half-life (T )

Kel =

CL
Vd

T =

0.693 (Vd )
CL

4. Select appropriate dosing interval () (usually 1-2 T s)

(12, 24, 48, etc.)
5. Calculate Dose to achieve target trough (5-20 mg/L)
Rybak MJ, et al. Pharmacotherapy 1999;19:257-66

Trough (1 e k )(V )
Dose =
e k
6. Confirm trough concentration if dose rounded

Dose
Trough = Vd K e K
1 e

K=

Dose
+ Trough
Vd
ln
Trough

T =

0.693
K

CL = K [0.17 (Age) + 0.22 (TBW) + 15]

2. Select appropriate dosing interval () (usually 1-2 T s)
(12, 24, 48, etc.)
3. Calculate Dose to achieve target trough (5-20 mg/L)

Trough (1 e k )(V )
Dose =
e k
4. Confirm trough concentration if dose rounded

Dose
Trough = Vd K e K
1 e