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Development and implementation of simplified aminoglycoside empiric dosing guidelines
C Reesor Nimmo1, F Mamdani, A Baker
1Department of Pharmacy, Vancouver General Hospital, BC, Canada.
Pharmacotherapy
|July 1, 1993
Summary
Poor dosing of aminoglycosides like gentamicin and tobramycin (G-T) is a common issue. New, simplified dosing guidelines improved initial G-T serum concentrations, enhancing patient treatment outcomes.
Area of Science:
- Pharmacology
- Clinical Pharmacy
- Infectious Diseases
Background:
- Aminoglycoside dosing, specifically gentamicin and tobramycin (G-T), presents challenges in achieving therapeutic serum concentrations in hospital settings.
- Suboptimal initial dosing can lead to reduced efficacy and increased toxicity.
- Existing dosing methods often require complex calculations, contributing to errors.
Purpose of the Study:
- To evaluate the effectiveness of gentamicin and tobramycin (G-T) dosing at an institution.
- To develop and implement practical, simplified dosing guidelines for G-T to achieve optimal initial serum concentrations.
- To assess the impact of these new guidelines on G-T dosing practices and patient outcomes.
Main Methods:
- A two-phase study was conducted, including a pre-intervention (phase 1) and post-intervention (phase 2) period.
- Empiric dosing guidelines were developed based on institutional data and literature, focusing on age, total weight, and serum creatinine.
- Guidelines were presented in a tabular format to minimize prescriber calculations and were distributed widely.
Main Results:
- In phase 1, approximately one-third of G-T treatment courses had low initial serum concentrations.
- The implemented guidelines led to an increased mean initial dose per interval in phase 2 (p < 0.01).
- Adherence to the new guidelines significantly increased the proportion of treatment courses achieving target therapeutic serum concentrations (80% vs 54%, p < 0.005).
Conclusions:
- The developed empiric dosing guidelines for gentamicin and tobramycin are practical and effective.
- These guidelines simplify the dosing process, reducing the need for complex prescriber calculations.
- Implementation of these guidelines improves the achievement of initial therapeutic aminoglycoside serum concentrations, offering a viable alternative to current methods.