Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
The following guideline is approved only for use at University College London Hospitals NHS Foundation Trust. It is provided as supporting information for the UCLH Injectable Medicines Administration Guide. Neither UCLH nor Wiley accept liability for errors or omissions within the guideline. Wherever possible, users of the Guide should refer to locally produced practice guidelines. UCLH’s guidelines represent the expert opinion of the clinicians within the hospital and may not be applicable to patients outside the Trust. Gentamicin Dosing Guideline - Paediatric & Young People Policy Procedure Guideline Trust-wide Document Control Information Approved by: Executive Board Date approved: 14 December 2009 Version: 2 Original Publication date: December 2009 Review Date: 1st November 2011 Author: Dr P Wilson, Consultant Microbiologist Dr A Sutcliffe, Consultant Paediatrician & Senior Lecturer in Child Health Mr N Tickner, Paediatric Pharmacist Responsible Director: Responsible Committee: Prof Tony Mundy, Medical Director Antimicrobial Usage Committee Target Audience: Medical, nursing and pharmacy staff Related documents/policies: Number of pages and appendices: Equalities Impact Assessment: Aspect/s of equalities duties that relate to this Policy 6 Low UCL Hospitals is an NHS Foundation Trust comprising: the Eastman Dental Hospital, Elizabeth Garrett Anderson & Obstetric Hospital, The Heart Hospital, Hospital for Tropical Diseases, National Hospital for Neurology & Neurosurgery, The Royal London Homoeopathic Hospital and University College Hospital (incorporating the Middlesex Hospital) UCL HOSPITALS NHS FOUNDATION TRUST Gentamicin Dosing Guideline (Paediatric & Young People) CONTENTS PAGE NUMBER Indication and Purpose 2 Objectives 2 Scope 2 Development and consultation 2 Implementation, monitoring and documentation 2 Rationale 3 Patient Exclusion 3 Administration and recording of initial dose 3 Obesity 3 Monitoring 3 Second and subsequent doses 4 Monitoring of measured level 4 Inappropriate levels 4 References 5 Further information 5 UCLH-2009 Published date: December 2009 Review date: November 2011 Policies, procedures and guidelines only current on date printed refer to Insight for definitive version 1 UCL HOSPITALS NHS FOUNDATION TRUST Gentamicin Dosing Guideline (Paediatric & Young People) Introduction and Purpose UCLH Antimicrobial Guidelines are intended to provide clinicians guidance on the management (both treatment and prevention) of common infections. This guideline forms part of a series of antimicrobial guidelines. The clinical guidelines provide evidence based and best practice on the management of patients with infective episodes. They include empirical antimicrobial therapy including dose, route and duration of therapy and where necessary microbiological investigations. Objectives • • • • To improve the quality of antimicrobial prescribing and reduce inappropriate prescribing. To maximise the clinically effectiveness of antimicrobial agents used. To reduce drug related toxicity and development of antimicrobial resistance. To ensure cost effective use of antimicrobial agents. Scope This guideline applies to all healthcare professionals involved in the prescription, administration and monitoring of antimicrobial agents. Development and consultation The clinical guidelines have been produced by the lead clinician and lead pharmacist for each division in conjunction with microbiology. Implementation and Monitoring and documentation Approved antimicrobial guidelines will be housed on the UCLH intranet formulary (Inform) and can be accessed at http://pharmweb/Inform/Index.aspx Implementation and adherence to the guidelines is the responsibility of the lead clinician and lead pharmacist for each division. Key aspects of the guidelines will be monitored as part of the annual audit programme. UCLH-2009 Published date: December 2009 Review date: November 2011 Policies, procedures and guidelines only current on date printed refer to Insight for definitive version 2 UCL HOSPITALS NHS FOUNDATION TRUST Gentamicin Dosing Guideline (Paediatric & Young People) Rationale This guideline applies to patients >1 month of age to 18 years age. Prescribing gentamicin as a single daily dose ensures that target peak concentrations are achieved in all patients. Once daily dosing is at least as effective and less nephrotoxic than multiple daily dosing. Patient Exclusion Once daily dosing is NOT appropriate for all neonates and babies <1 month of gestational age OR any child/young person in the following situations: ♦ severe renal impairment (CrCl <20ml/min) ♦ cystic fibrosis ♦ endocarditis (consult Microbiologist) ♦ major burns ♦ prophylaxis ♦ pregnancy ♦ ascites/severe liver disease/jaundice (bilirubin >50 micromol/L) For the above groups conventional gentamicin dosing must be used. Administration and recording of initial dose Prescribe 7mg/kg gentamicin in 100 ml (20 - 50 ml for infants and young children) glucose 5% or sodium chloride 0.9% administered by intravenous infusion over one hour as a stat dose. The actual infusion start time must be recorded on the in-patient prescription form. The dose must be prescribed on the ‘once only’ side of the chart. Obesity • • • For obese patients with a body mass index (BMI) over the 95th centile, use ‘ideal weight for height’ to calculate the dose. To calculate ideal weight for height, plot height on growth chart to identify height-for-age percentile. Locate ideal weight as the weight at the same percentile as the height, for the same age and sex. Monitoring • • Take a single blood sample, at any time between 6 - 14 hours after the actual start of the first infusion. It is essential that the time of start of the infusion and time the blood sample is taken is recorded accurately and documented on the Microbiology assay request form. UCLH-2009 Published date: December 2009 Review date: November 2011 Policies, procedures and guidelines only current on date printed refer to Insight for definitive version 3 UCL HOSPITALS NHS FOUNDATION TRUST Gentamicin Dosing Guideline (Paediatric & Young People) Second and subsequent doses Await interpretation of the first level before prescribing the second dose. The dosing interval will be recommended as 24, 36 or 48 hours, depending on the level measured. The dose will remain constant at 7 mg/kg. The second and subsequent doses can be prescribed on the regular section of the drug chart. Interpretation of measured level The gentamicin level is evaluated via the Hartford nomogram. If the level falls in the area designated Q24h, Q36h or Q48h, the interval should be every 24, 36 or 48 hours respectively. If the level falls on the line, choose the longer dosing interval. If the level is off the nomogram at the given time, the scheduled therapy should be stopped and serial levels followed to determine the appropriate time of the next dose (when the level falls below 1.0 mg/L). Where appropriate monitor the blood gentamicin level twice weekly using the same method. HARTFORD NOMOGRAM 14 13 12 Do NOT give another dose until level < 1 mg/L Concentration (mg/L) 11 Q48h 10 9 8 Q36h 7 6 5 Q24h 4 3 2 6 7 8 9 10 11 12 13 14 Time between start of infusion and sample draw (hrs) Inappropriate levels If for any reason a level is missed or is not taken appropriately, a trough level can be recommended immediately before the next dose. This should be less than 0.5mg/L. UCLH-2009 Published date: December 2009 Review date: November 2011 Policies, procedures and guidelines only current on date printed refer to Insight for definitive version 4 UCL HOSPITALS NHS FOUNDATION TRUST Gentamicin Dosing Guideline (Paediatric & Young People) References 1. Nicolau D. et al. Experience with a once daily aminoglycoside program administered to 2,184 adult patients. Antimicrobial Agents and Chemotherapy 1995; 35: 650-655. Further information General paed/adolescent clinical Pharmacist Paed/adolescent Oncology Pharmacist Microbiology bleep 6701 bleep 2300 ext 9515 / 8388 UCLH-2009 Published date: December 2009 Review date: November 2011 Policies, procedures and guidelines only current on date printed refer to Insight for definitive version 5