GuidelinesOther guideline
Therapeutic Drug Monitoring for Aminoglycosides and Vancomycin
The current recommended empiric antibiotic choices and empiric durations for suspected bacterial infections at CHBAH, based on consensus agreement between Infectious Diseases (ID), Microbiology and specialties after review of our 2018 antibiogram data, is as follows until directed therapy is possible.
|
Drug
|
Dose
|
Dosing Interval
|
Trough Level
|
Peak level
|
|
Amikacin
|
Adult: 15mg/kg/day (max 1.5g/day). Dose adjust in renal failure: loading dose 10mg/kg, with further doses according to plasma levels. Paediatric: 15-20mg/kg/day (max 360mg daily). Neonates: 15mg/kg/day (use with caution in neonates). |
Daily | Measure trough levels immediately prior to the 3rd dose (prior to 2nd dose if renal dysfunction present). Target trough level is <1mg/L. If trough levels >5mg/L, increase dosing interval to 36-48 hours, and re-measure after a further 2 doses have been given. |
Measure peak levels one hour after commencing intravenous infusion, or one hour after an IMI or IV bolus dose. Target peak levels: >30 mg/L (Amikacin); >8 g/L (Gentamicin). For Aminoglycoside TDM calculation assistance by pharmacy: 1. Patient weight, 2. Times of: Administration, Peak and trough levels. 3. Dosage and frequency 4. Peak and trough concentrations. |
|
Gentamicin
|
Adult: 5-6mg/kg/day (max 1.5 g/day). Dose adjust in renal failure: loading dose 3-4 mg/kg, with further doses according to plasma levels. Paediatric: 5-7.5 mg/kg/day (max 360mg daily). Neonates: 6 mg/kg/day in two divided doses (use with caution in neonates). |
Daily (twice daily in neonates) | ||
|
Vancomycin
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Adult: IV infusion over at least 1 hour, 15-20mg/kg 12 hourly (consider a loading dose of 25-30mg/kg in seriously ill patients). Increase dosing interval in renal failure. Paediatric: IV infusion over at least 1 hour, 15mg/kg 6 hourly. Neonates: IV infusion over at least 1 hour, <1 week 15mg/kg initial dose, followed by 10mg/kg 12 hourly; 1 week – 1 month 15mg/kg initial dose, followed by 10mg/kg 12 hourly. |
6-12 hourly | Measure trough levels immediately prior to the third dose. Target trough level 10-15μg/mL. For complicated Staphylococcus aureus infections (bacteraemia, endocarditis), 15-20μg/mL. If trough <10μg/mL, increase the dose. If peak >15μg/mL, increase the dosing interval. |
Source: South African Medicines Formulary, 11th Edition 2014