Gentamicin once daily regimen with Hartford Nomogram (agreed by Yorkshire regional group). - Adults
|Next review: 20/09/2022|
Supported by: Yorkshire Antibiotic Pharmacists Group
Approved By: Improving Antimicrobial Prescribing Group
|Copyright© Leeds Teaching Hospitals NHS Trust 2019|
This Clinical Protocol is intended for use by healthcare professionals within Leeds unless otherwise stated.
Yorkshire Hartford Gentamicin Regimen (Adults)
- Step 1: Is the patient suitable?
- Step 2: Calculate the dose
- Step 3: How to give gentamicin
- Step 4: How to measure gentamicin levels
- Step 5: Selecting the dose interval
- Step 6: Repeated monitoring
This regimen gives a standard dose of gentamicin of 7mg/kg calculated from ideal body weight.
A serum level is measured 6-14 hours after the first dose to determine the dosage interval (1).
- Calculate creatinine clearance (mL/minute):-
Men 1.23 x (140 – age) x weight in kg Women 1.04 x (140 – age) x weight in kg serum creatinine (micromol/L) serum creatinine (micromol/L)
|Do NOT use this regimen for|
- Find out the patient's sex, height, weight in kg
- Read off the patient’s ideal body weight (IBW) for their sex and their height from the appropriate chart below
- Compare the patient’s actual body weight (ABW) with their ideal body weight (IBW)
- If the patient’s ABW is less than their IBW (i.e. they are underweight), use their ABW to estimate the gentamicin dose from the charts below
- If the patient’s ABW is more than, or the same as, their IBW, use their IBW to estimate the gentamicin dose from the charts below
(To convert from imperial weight measurements to metric 1 stone = 6.35kg 1 lb = 0.45kg)
- Dilute the gentamicin dose in 100mL sodium chloride 0.9% and give by intravenous infusion over 1 hour.
- Record on the drug chart the exact start time of the infusion.
- Most laboratories are able to do assays daily but not out of hours. Take a blood sample at the right time and the sample will be analysed in hours and the result should be available before the next dose is due.
- Do not take the blood sample from the IV line used for gentamicin administration.
- Take one blood sample (ideally 10mL) between 6 and 14 hours after the start of the first infusion.
- Place sample in a plain tube (i.e. clotted blood).
- Document on the microbiology request form the EXACT time and date the infusion was set up (see prescription chart) and the EXACT time and date the sample was taken in addition to the patient details and Hartford Gentamicin Regimen
- The specimen bottle must show the
- patients name
- date of birth
- date and time the sample was taken
When the gentamicin level is available:-
IBW calculations Female IBW = 45kg + (2.3kg x no. of inches over 5 feet) Male IBW = 50kg + (2.3kg x no. of inches over 5 feet)
If patient is < 5 feet tall, use IBW = 45kg (females) or 50kg (males)
Box for local information – lab opening times / out of hours arrangements etc
OBTAIN FURTHER ADVICE FROM THE CONSULTANT MICROBIOLOGIST (EXT …)
|Target patient group:||Adults|
|Target professional group(s):||Secondary Care Doctors
(1) Antimicrobial Agents and Chemotherapy March 1995 ; 39 : 650-655
Improving Antimicrobial Prescribing Group
LHP version 1.0
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