Download Gentamicin Dosing Guideline - UCL Hospitals Injectable Medicines

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