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- Jan 8, 2007
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Loading dose of Amikacin in hemodialysis patient with CrCl of 17?
This is the second AG, but still feverish. I wish I had 3 days to figure that out, but the empirical clock is ticking.Yeah why not another AG. What's the bug
Do you determine trough or just dialyze? The most cautious was is to get a CrCl and trough separately from HD. Patient's getting pretty weak.Why are you calculating CrCl on an HD patient?
That's what we came up with too...Amikacin is a good drug.
Not worried about renal toxicity.
I would go with 7.5mg/kg for a peak of 30. After dialysis just replace the dialyzes amount. If worried about ototoxicity....maybe 1/2 the dose
Trough above 10 is supposedly toxic.Crcl is irrelevant. Trough is not important. Ag. Is concentration dependant bactericidal.
That's what we came up with too...
"First, initiate therapy by administering a normal dose, 7.5 mg/kg, as a loading dose. This loading dose is the same as the normally recommended dose which would be calculated for a patient with a normal renal function as described above." - www.globalrph.com/amikacin_renal.htm
Trough above 10 is supposedly toxic.
"...above 10 micrograms per mL should be avoided"
No, but in this case, dialysis may or may not be an option.Do you even factor in "CrCl" if patient is on HD?
ESRD. What am I going to do, walk them down to dialysis myself?What are you going to do, kill their kidneys?
(then the question comes to are they ESRD or AKI)
Supply problem?... No, not at this moment.Is amikacin still on shortage? I know it was a problem last year.
Is it being started empirically or do you have old cultures?
Multiple comorbidities, LTC patient. Hmmm... I don't think microbial history is important at this point. Current chief complaint: why haven't I gone to hospice already?What is the patient's PMH? Microbiology history? Current chief complaint?
... in the mean time... during her time off, PharmDstudent is thinking...Bueller?
I would hope so. It's an LTAC facility, afterall.Amikacin is being distributed on a need-based basis...does this patient qualify? Things we need to know.
The labs are still pending.2nd AG? Resistance? Amikacin is still in short supply at my institution.
really OT but, i was studying for my NAPLEX and had a question
Using nebulized TOBI for CF, do you need to get drug levels?
Empirically. Previous cultures are still pending.
Multiple comorbidities, LTC patient. Hmmm... I don't think microbial history is important at this point. Current chief complaint: why haven't I gone to hospice already?
The labs are still pending.
PharmDstudent was just asking for the dosing, not the choice of drug.
Right. The ID specialist was in charge of drug choice, cultures, etc.AG have their place...they work great. I love giving them to HD patients because I don't need to worry about losing their kidneys.
ID rookies...throwing out the meropenem, that is poor stewardship.
It is too hard to tell what the best option for the patient based on the information given. PharmDstudent was just asking for the dosing, not the choice of drug.
Try finding the dose yourself. It wasn't straightforward and had to be determined using our "best judgement". It took us a while to find the right numbers to hang our hat on.anyone can look up dosing on lexi or micromedex. generally when i verify/send orders i like to have some sort of idea of why they picked that drug. and i don't come from an area with high resistance to AGs, so this is somewhat bizzare to me. is this not a thread for clinical discussion?