How should aminoglycosides be adjusted for hemodialysis

How should aminoglycosides be adjusted for hemodialysis?

First, the patient’s dosing weight should be determined. Use ideal body weight (IBW) unless total body weight (TBW) is less.

  • • Nonobese is: TBW < 130% of IBW
  • • IBW (males) = 50 kg + (2.3 × height in inches >60 inches)
  • • IBW (females) = 45 kg + (2.3 × height in inches >60 inches)
  • • In patients who are obese, adjust IBW: ABW (kg) = IBW + 0.4 (TBW − IBW), where ABW is actual body weight.

Second, select the appropriate loading and maintenance doses:

  • • Loading dose should be considered in life-threatening infection (for gentamicin and tobramycin, give 2.5 mg/kg; for amikacin give 7.5 mg/kg as a loading dose).
  • • Select appropriate maintenance dose according to indications

Aminoglycoside Dosing in Patients Undergoing Dialysis


DRUG
HEMODIALYSIS (DOSE POSTDIALYSIS)PERITONEAL DIALYSIS (EVERY 48 H)*CONTINUOUS RENAL REPLACEMENT THERAPY (EVERY 24 H)
Gentamicin
Serious infection
Urinary tract infection
Synergy
1.5–2 mg/kg
1 mg/kg
1 mg/kg
1.5–2 mg/kg
1 mg/kg
1 mg/kg
1.5–2 mg/kg
1 mg/kg
1 mg/kg
Tobramycin
Urinary tract infection
1.5–2 mg/kg
1 mg/kg
1.5–2 mg/kg
1 mg/kg
1.5–2 mg/kg
1 mg/kg
Amikacin7.5 mg/kg7.5 mg/kg7.5 mg/kg
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