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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 |
| Amikacin | 7.5 mg/kg | 7.5 mg/kg | 7.5 mg/kg |
