Are you going to take over Conan when he replaces Leno? You are a pretty funny guy.....
I would like to put together an 1 hour routine...for ASHP... perhaps one day.
So this female pharmacist has been having a dispute with the clinical coordinator over once daily aminoglycoside...she felt that in order for it to work, the trough should be around 2ug/ml....which is the primary reason for the renal toxicity..sustained high trough.. So she was walking by and the DOP said..."hey...Mary...here is a guy you need to talk to about the aminoglycoside.."
But the looks of her told me if I give her a second...she wouldn't shut up.. so I said...
Mary Mary extraordinary.. your 80mg q8h will result in trought of 2ug/ml every 8 hours..which causes renal toxicity..here is what we should do, load the patient with 7mg/kg..shoot the level up to 28ug/ml which is about 10 times the MIC which we think is the most efficacious bacteriocidal concentration ..then the let the level drop off to below 0.6ug/ml (my nephew's laptop, the five key doesn't work) and let it stay there for over 14 hours..or so..and because of post antibiotic effect and because aminoglycoside is bacteriocidal by intracelluar mechanism, the low trough is ok...also because it gives kidneys time to recover...and also it increases susceptibility of bugs when there is low level of gent in blood.....so we if the t1/2 is about 3 hours, then in 3 hours, the level falls to 14, then in 6 hours....to 7, and then in 9 hours, the level is 3.6 then in 12 hours the level is 1.76..then in 16 hours, the level is 0.876...on and on...and that is the way we should dose it..not trying to dose it your way by keeping the trough high..which is the #1 reason we fry kidneys..and I don't like to eat kidneys...
And I said all this without breathing...and then I looked at my blackberry..and said...goodness Mary..I gotta go to a meeting..Nice meeting you, here is my card. email me... bye. True story. Happend on Wednesday. She hasn't emaild me yet. But I got a request from the hospital to provide antibiotic competency for the pharmacy department...
